Provider Demographics
NPI:1003512500
Name:COMFORT MEDICAL CENTER PHOENIX BLVD, LLC
Entity Type:Organization
Organization Name:COMFORT MEDICAL CENTER PHOENIX BLVD, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HEALTHCARE ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:NAKITA
Authorized Official - Middle Name:
Authorized Official - Last Name:PIPER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-480-2529
Mailing Address - Street 1:1903 PHOENIX BLVD STE 125
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30349-5754
Mailing Address - Country:US
Mailing Address - Phone:404-982-4228
Mailing Address - Fax:404-275-0676
Practice Address - Street 1:1903 PHOENIX BLVD STE 125
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30349-5754
Practice Address - Country:US
Practice Address - Phone:404-982-4228
Practice Address - Fax:404-275-0676
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-06
Last Update Date:2023-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty