| Organization Name: | MID PHYSICIAN NETWORK (OH), LLC |
| NPI Number: | 1982077590 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | ADRIAN DAVIS (CHIEF EXECUTIVE OFFICER) |
| Mailing Address: | 5665 New Northside Dr Suite 520 Atlanta |
| State: | GA US |
| Postal Code: | 303285831 |
| Phone Number: | 8558794332 |
| Fax Number: | |
| NPI Enumeration Date: | 11/04/2015 |
| NPI Last Update Date: | 11/04/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 208D00000X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | General Practice |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |