Provider Demographics
NPI:1033502877
Name:DRAWBRIDGE MEDICAL, LLC
Entity Type:Organization
Organization Name:DRAWBRIDGE MEDICAL, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS DEVELOPMENT EXECUTIVE
Authorized Official - Prefix:
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:HAYES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-486-7340
Mailing Address - Street 1:5700 HIGHLANDS PKWY SE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SMYRNA
Mailing Address - State:GA
Mailing Address - Zip Code:30082-5142
Mailing Address - Country:US
Mailing Address - Phone:678-486-7340
Mailing Address - Fax:
Practice Address - Street 1:160 VERSAILLES RD
Practice Address - Street 2:
Practice Address - City:FRANKFORT
Practice Address - State:KY
Practice Address - Zip Code:40601-3208
Practice Address - Country:US
Practice Address - Phone:678-486-7340
Practice Address - Fax:678-305-0531
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-17
Last Update Date:2015-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty