Provider Demographics
NPI:1225564677
Name:ONE HEALTH RESEARCH CLINIC, INC
Entity Type:Organization
Organization Name:ONE HEALTH RESEARCH CLINIC, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SITE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SYLVIA
Authorized Official - Middle Name:
Authorized Official - Last Name:FISCHER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-585-4917
Mailing Address - Street 1:5430 JIMMY CARTER BLVD
Mailing Address - Street 2:SUITE 200B
Mailing Address - City:NORCROSS
Mailing Address - State:GA
Mailing Address - Zip Code:30093-1517
Mailing Address - Country:US
Mailing Address - Phone:678-585-4917
Mailing Address - Fax:678-691-8129
Practice Address - Street 1:5430 JIMMY CARTER BLVD
Practice Address - Street 2:SUITE 200B
Practice Address - City:NORCROSS
Practice Address - State:GA
Practice Address - Zip Code:30093-1517
Practice Address - Country:US
Practice Address - Phone:678-585-4917
Practice Address - Fax:678-691-8129
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-04
Last Update Date:2017-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA9270170100000X
GA30147170100000X
GA35421170100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes170100000XOther Service ProvidersMedical Genetics, Ph.D. Medical GeneticsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1235345588Other1235345588
GA1225028947Other1225028947
GA1669555819Other1669555819
GA1710088505Other1710088505