1275839235 NPI number — HYPERBARXS AT JOHNS CREEK, LLC

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 1275839235 NPI number — HYPERBARXS AT JOHNS CREEK, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HYPERBARXS AT JOHNS CREEK, LLC
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:
1275839235
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/16/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1341 CANTON RD
Provider Second Line Business Mailing Address:
SUITE: A
Provider Business Mailing Address City Name:
MARIETTA
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30066-6056
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
770-422-0517
Provider Business Mailing Address Fax Number:
678-638-7015

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2575 PEACHTREE PKWY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CUMMING
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30041-7559
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
770-888-8777
Provider Business Practice Location Address Fax Number:
678-638-7015
Provider Enumeration Date:
02/08/2011

Additional Information

Authorized Official

Authorized Official Last Name:
GELLY
Authorized Official First Name:
HELEN
Authorized Official Middle Name:
B
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
770-422-0517

Provider Taxonomy Codes

  • Taxonomy code: 261Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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