1982170817 NPI number — HEALTH-E LLC

Table of content: (NPI 1982170817)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1982170817 NPI number — HEALTH-E LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HEALTH-E 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:
HEALTH-E MEDICAL CENTER
Provider Other Organization Name Type Code:
3
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:
1982170817
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/16/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1466 COUNTRY SQUIRE DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DECATUR
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30033-2414
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
770-680-2949
Provider Business Mailing Address Fax Number:
770-504-6045

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1462 MONTREAL RD STE 305
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TUCKER
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30084-6924
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
704-264-6041
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/18/2018

Additional Information

Authorized Official

Authorized Official Last Name:
EVANS
Authorized Official First Name:
AKITA
Authorized Official Middle Name:
Authorized Official Title or Position:
MEDICAL DIRECTOR
Authorized Official Telephone Number:
704-264-6041

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 003111402K , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".




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