Provider Demographics
NPI:1205410032
Name:MY ONLINE DOCTOR'S VISIT LLC
Entity Type:Organization
Organization Name:MY ONLINE DOCTOR'S VISIT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:DINGANE
Authorized Official - Middle Name:
Authorized Official - Last Name:BARUTI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:866-448-8319
Mailing Address - Street 1:1870 THE EXCHANGE SE STE 200-44
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30339-2036
Mailing Address - Country:US
Mailing Address - Phone:866-448-8319
Mailing Address - Fax:
Practice Address - Street 1:5651 TUXEDO DR
Practice Address - Street 2:
Practice Address - City:DOUGLASVILLE
Practice Address - State:GA
Practice Address - Zip Code:30135-7526
Practice Address - Country:US
Practice Address - Phone:678-444-8780
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-07
Last Update Date:2021-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty