1790234086 NPI number — U.S. HEALTHWORKS MEDICAL GROUP OF GEORGIA, INC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1790234086 NPI number — U.S. HEALTHWORKS MEDICAL GROUP OF GEORGIA, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
U.S. HEALTHWORKS MEDICAL GROUP OF GEORGIA, INC.
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:
1790234086
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/27/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
25124 SPRINGFIELD CT
Provider Second Line Business Mailing Address:
SUITE 200
Provider Business Mailing Address City Name:
VALENCIA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91355-1085
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
661-678-2600
Provider Business Mailing Address Fax Number:
661-678-2700

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
470 FRANKLIN GTWY SE
Provider Second Line Business Practice Location Address:
SUITE 103
Provider Business Practice Location Address City Name:
MARIETTA
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30067-7739
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
770-428-8900
Provider Business Practice Location Address Fax Number:
770-426-8444
Provider Enumeration Date:
09/27/2016

Additional Information

Authorized Official

Authorized Official Last Name:
MALLAS
Authorized Official First Name:
JOSEPH
Authorized Official Middle Name:
T
Authorized Official Title or Position:
PRESIDENT & CHIEF EXECUTIVE OFFICER
Authorized Official Telephone Number:
661-678-2600

Provider Taxonomy Codes

  • Taxonomy code: 2083X0100X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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