Provider Demographics
NPI:1104196062
Name:ALLIED MEDICAL CENTER, LLC
Entity Type:Organization
Organization Name:ALLIED MEDICAL CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:TERRY
Authorized Official - Middle Name:
Authorized Official - Last Name:DO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:678-328-0577
Mailing Address - Street 1:2484 BRIARCLIFF RD NE
Mailing Address - Street 2:SUITE 22, #337
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30329-3011
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2700 W UNIVERSITY DR
Practice Address - Street 2:SUITE 1060
Practice Address - City:DENTON
Practice Address - State:TX
Practice Address - Zip Code:76201-1610
Practice Address - Country:US
Practice Address - Phone:678-328-0577
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-10
Last Update Date:2012-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX07845111N00000X
TX11358111N00000X
TXM4580207QS1201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QS1201XAllopathic & Osteopathic PhysiciansFamily MedicineSleep MedicineGroup - Multi-Specialty
No111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty