Provider Demographics
NPI:1043070345
Name:NOBLE STAR HEALTH
Entity Type:Organization
Organization Name:NOBLE STAR HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:LEVAR
Authorized Official - Last Name:CONLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-201-0855
Mailing Address - Street 1:550 HAMILTON E HOLMES DR NW
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30318-6151
Mailing Address - Country:US
Mailing Address - Phone:404-201-0855
Mailing Address - Fax:
Practice Address - Street 1:550 HAMILTON E HOLMES DR NW
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30318-6151
Practice Address - Country:US
Practice Address - Phone:404-201-0855
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-21
Last Update Date:2024-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care