1538343439 NPI number — TOTAL HEALTH MEDICAL CENTER CORPORATION

Table of content: (NPI 1538343439)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1538343439 NPI number — TOTAL HEALTH MEDICAL CENTER CORPORATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TOTAL HEALTH MEDICAL CENTER CORPORATION
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:
6
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:
1538343439
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/17/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3009 RAINBOW DR
Provider Second Line Business Mailing Address:
STE.139
Provider Business Mailing Address City Name:
DECATUR
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30034-1680
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
404-241-7062
Provider Business Mailing Address Fax Number:
404-243-0357

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4153 FLAT SHOALS PKWY
Provider Second Line Business Practice Location Address:
BLDG A, STE 104
Provider Business Practice Location Address City Name:
DECATUR
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30034-1680
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
404-241-7062
Provider Business Practice Location Address Fax Number:
404-243-0357
Provider Enumeration Date:
12/27/2007

Additional Information

Authorized Official

Authorized Official Last Name:
LESLIE
Authorized Official First Name:
HARVEY
Authorized Official Middle Name:
B
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
404-241-7062

Provider Taxonomy Codes

  • Taxonomy code: 173000000X , with the licence number:  027597 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 174400000X , with the licence number: 027597 , 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)





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