Provider Demographics
NPI:1043612922
Name:HDH HEALTHCARE GROUP, LLC
Entity Type:Organization
Organization Name:HDH HEALTHCARE GROUP, LLC
Other - Org Name:MOMENTUM PRIMARY CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JARED
Authorized Official - Middle Name:
Authorized Official - Last Name:DERANEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-482-0934
Mailing Address - Street 1:PO BOX 935719
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:31193-2177
Mailing Address - Country:US
Mailing Address - Phone:678-430-8478
Mailing Address - Fax:
Practice Address - Street 1:120 HANDLEY RD
Practice Address - Street 2:#400
Practice Address - City:TYRONE
Practice Address - State:GA
Practice Address - Zip Code:30290-2177
Practice Address - Country:US
Practice Address - Phone:404-597-9523
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HDH, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-09-22
Last Update Date:2021-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA033776207R00000X
261QU0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00469092AMedicaid
GA00469092AMedicaid
GA11SCGCKMedicare PIN