1558528810 NPI number — BETTER HEALTH MEDICAL GROUP

Table of content: (NPI 1558528810)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1558528810 NPI number — BETTER HEALTH MEDICAL GROUP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BETTER HEALTH MEDICAL GROUP
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1558528810
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/22/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3985 STEVE REYNOLDS BLVD
Provider Second Line Business Mailing Address:
SUITE K 102
Provider Business Mailing Address City Name:
NORCROSS
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30093-3035
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
678-367-0390
Provider Business Mailing Address Fax Number:
678-245-3391

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3985 STEVE REYNOLDS BLVD
Provider Second Line Business Practice Location Address:
SUITE K 102
Provider Business Practice Location Address City Name:
NORCROSS
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30093-3035
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
678-367-0390
Provider Business Practice Location Address Fax Number:
678-245-3391
Provider Enumeration Date:
05/22/2008

Additional Information

Authorized Official

Authorized Official Last Name:
PHAM
Authorized Official First Name:
TRUC
Authorized Official Middle Name:
Authorized Official Title or Position:
PHYSICIAN
Authorized Official Telephone Number:
678-367-0390

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  049706 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 001475 . This is a "BCBS" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: 08BBQNQ . This is a "MEDICARE" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: 844204821B , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: H98477 . This is a "UPIN" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: 844204821A , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".




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