Provider Demographics
NPI:1073070991
Name:HIP MEDICAL GEORGIA,LLC
Entity Type:Organization
Organization Name:HIP MEDICAL GEORGIA,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MULTISITE CLINIC MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:BUSHRA
Authorized Official - Middle Name:
Authorized Official - Last Name:SIDDIQI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-796-6940
Mailing Address - Street 1:2500 OLD MILTON PKWY STE 210
Mailing Address - Street 2:
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30009-2486
Mailing Address - Country:US
Mailing Address - Phone:678-796-6940
Mailing Address - Fax:
Practice Address - Street 1:11660 ALPHARETTA HWY STE 285
Practice Address - Street 2:
Practice Address - City:ROSWELL
Practice Address - State:GA
Practice Address - Zip Code:30076-3876
Practice Address - Country:US
Practice Address - Phone:404-255-5774
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-27
Last Update Date:2019-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty