Provider Demographics
NPI:1093985343
Name:CLINICA DE LA SALUD HISPANA LLC
Entity Type:Organization
Organization Name:CLINICA DE LA SALUD HISPANA LLC
Other - Org Name:CLINICA DE LA SALUD HISPANA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:EDGAR
Authorized Official - Middle Name:MIGUEL
Authorized Official - Last Name:VELEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-888-0173
Mailing Address - Street 1:969 WINDY HILL RD SE
Mailing Address - Street 2:SUITE E
Mailing Address - City:SMYRNA
Mailing Address - State:GA
Mailing Address - Zip Code:30080-2003
Mailing Address - Country:US
Mailing Address - Phone:678-888-0173
Mailing Address - Fax:678-888-0177
Practice Address - Street 1:969 WINDY HILL RD SE
Practice Address - Street 2:SUITE E
Practice Address - City:SMYRNA
Practice Address - State:GA
Practice Address - Zip Code:30080-2003
Practice Address - Country:US
Practice Address - Phone:678-888-0173
Practice Address - Fax:678-888-0177
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-03
Last Update Date:2008-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty