| Organization Name: | ELEVEN 11 MEDICAL MANAGEMENT, LLC |
| NPI Number: | 1356616338 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | CYNTHIA TATE (ADMINISTRATOR) |
| Mailing Address: | 438 Henry Ford Ii Ave Hapeville |
| State: | GA US |
| Postal Code: | 303541622 |
| Phone Number: | 6782352401 |
| Fax Number: | 6782352403 |
| NPI Enumeration Date: | 03/09/2012 |
| NPI Last Update Date: | 03/09/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 207KA0200X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | Allergy & Immunology |
| Taxonomy Specialization: | Allergy |
| Taxonomy Definition: | |