Organization Name: | HBISC |
NPI Number: | 1306247663 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | OWEN HENDRICKS (CEO) |
Mailing Address: | 3118 Esplanade Cir Sw Atlanta |
State: | GA US |
Postal Code: | 303114221 |
Phone Number: | 4042453900 |
Fax Number: | |
NPI Enumeration Date: | 09/05/2014 |
NPI Last Update Date: | 09/05/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 208D00000X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | General Practice |
Taxonomy Specialization: | |
Taxonomy Definition: |