1619478856 NPI number — HEALTHCARE SYSTEMS OF GEORGIA LLC

Table of content: (NPI 1619478856)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1619478856 NPI number — HEALTHCARE SYSTEMS OF GEORGIA LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HEALTHCARE SYSTEMS OF GEORGIA 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:
1619478856
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/10/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 26116
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MACON
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
31221-6116
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
478-213-6401
Provider Business Mailing Address Fax Number:
888-687-4829

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
37 S SECOND AVE STE B
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MC RAE
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
31055-4658
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
404-844-9975
Provider Business Practice Location Address Fax Number:
888-687-4829
Provider Enumeration Date:
02/22/2018

Additional Information

Authorized Official

Authorized Official Last Name:
ECHEBELEM
Authorized Official First Name:
GEORGE
Authorized Official Middle Name:
Authorized Official Title or Position:
OPERATING OFFICER
Authorized Official Telephone Number:
404-844-9975

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 251E00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2025 www.npivalidator.com