Organization Name: | 360 MEDICAL MANAGEMENT |
NPI Number: | 1013161637 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | MYRON MOOREHEAD (MANAGING MEMBER) |
Mailing Address: | 200 Parkbrooke Dr Suite 200 Woodstock |
State: | GA US |
Postal Code: | 301896331 |
Phone Number: | 7705918360 |
Fax Number: | 7705918364 |
NPI Enumeration Date: | 11/10/2008 |
NPI Last Update Date: | 05/01/2009 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 174400000X |
License Number: | 058478 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | GA |
Taxonomy Type: | Other Service Providers |
Taxonomy Classification: | Specialist |
Taxonomy Specialization: | |
Taxonomy Definition: | An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree. |