Provider Demographics
NPI:1134639131
Name:HOLISTICA MEDICAL LLC
Entity Type:Organization
Organization Name:HOLISTICA MEDICAL LLC
Other - Org Name:CMS SURGICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KAYDEE
Authorized Official - Middle Name:
Authorized Official - Last Name:ZELGEWICZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-702-7500
Mailing Address - Street 1:2550 WINDY HILL RD SE STE 215
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30067-8654
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2550 WINDY HILL RD SE STE 215
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30067-8654
Practice Address - Country:US
Practice Address - Phone:770-345-2000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-04
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA1679765523OtherCIGNA