Organization Name: | EGLESTON AFFILIATED SERVICES |
NPI Number: | 1043384241 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | TOBY THOMAS (VICE PRESIDENT, MANAGED CARE) |
Mailing Address: | 3795 Mansell Rd Alpharetta |
State: | GA US |
Postal Code: | 300228247 |
Phone Number: | 4047857928 |
Fax Number: | |
NPI Enumeration Date: | 11/20/2006 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 261QU0200X |
License Number: | 044-079 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | GA |
Taxonomy Type: | Ambulatory Health Care Facilities |
Taxonomy Classification: | Clinic/Center |
Taxonomy Specialization: | Urgent Care |
Taxonomy Definition: |