Provider Demographics
NPI:1093434086
Name:FULL PLATE INDUSTRIES, LLC
Entity Type:Organization
Organization Name:FULL PLATE INDUSTRIES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRINCIPAL
Authorized Official - Prefix:MS
Authorized Official - First Name:KEISHA
Authorized Official - Middle Name:NICOLE
Authorized Official - Last Name:FORD-JENRETTE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-469-4212
Mailing Address - Street 1:900 DAMSON TRL
Mailing Address - Street 2:
Mailing Address - City:HAMPTON
Mailing Address - State:GA
Mailing Address - Zip Code:30228-4929
Mailing Address - Country:US
Mailing Address - Phone:678-469-4212
Mailing Address - Fax:
Practice Address - Street 1:320 LANIER AVE W STE 200
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30214-7443
Practice Address - Country:US
Practice Address - Phone:678-469-4212
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-24
Last Update Date:2022-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty