Provider Demographics
NPI:1003180563
Name:ADVANCED HEALTH SOLUTIONS, LLC
Entity Type:Organization
Organization Name:ADVANCED HEALTH SOLUTIONS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:
Authorized Official - Last Name:FEDERICO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:770-926-9495
Mailing Address - Street 1:13190 HIGHWAY 92
Mailing Address - Street 2:STE 70-90
Mailing Address - City:WOODSTOCK
Mailing Address - State:GA
Mailing Address - Zip Code:30188-4409
Mailing Address - Country:US
Mailing Address - Phone:770-926-9495
Mailing Address - Fax:770-926-9284
Practice Address - Street 1:13190 HIGHWAY 92
Practice Address - Street 2:STE 70
Practice Address - City:WOODSTOCK
Practice Address - State:GA
Practice Address - Zip Code:30188
Practice Address - Country:US
Practice Address - Phone:770-926-9495
Practice Address - Fax:770-926-9284
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-01
Last Update Date:2022-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
208100000X
GA66835111NI0900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NI0900XChiropractic ProvidersChiropractorInternistGroup - Multi-Specialty
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
202G356669Medicare PIN
GA35ZCJQLMedicare PIN