Provider Demographics
NPI:1003112392
Name:PRODIGY HEALTH SYSTEMS INC.,
Entity Type:Organization
Organization Name:PRODIGY HEALTH SYSTEMS INC.,
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:AMIR
Authorized Official - Middle Name:N
Authorized Official - Last Name:ADIRI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-891-3346
Mailing Address - Street 1:2670 COBB PKWY NW
Mailing Address - Street 2:
Mailing Address - City:KENNESAW
Mailing Address - State:GA
Mailing Address - Zip Code:30152-3443
Mailing Address - Country:US
Mailing Address - Phone:770-891-3346
Mailing Address - Fax:770-514-9665
Practice Address - Street 1:2670 COBB PKWY NW
Practice Address - Street 2:
Practice Address - City:KENNESAW
Practice Address - State:GA
Practice Address - Zip Code:30152-3443
Practice Address - Country:US
Practice Address - Phone:770-891-3346
Practice Address - Fax:770-514-9665
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-03
Last Update Date:2011-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA033-32341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance