Provider Demographics
NPI:1225566300
Name:ASPIRE FERTILITY GEORGIA, LLC
Entity Type:Organization
Organization Name:ASPIRE FERTILITY GEORGIA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REV CYCLE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:TSEY-HAYE
Authorized Official - Middle Name:Y
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-425-3003
Mailing Address - Street 1:6750 WEST LOOP S STE 395
Mailing Address - Street 2:
Mailing Address - City:BELLAIRE
Mailing Address - State:TX
Mailing Address - Zip Code:77401-4110
Mailing Address - Country:US
Mailing Address - Phone:713-425-3003
Mailing Address - Fax:
Practice Address - Street 1:6 CONCOURSE PKWY STE 250
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30328-6117
Practice Address - Country:US
Practice Address - Phone:678-274-6760
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-01
Last Update Date:2017-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
009JKOtherOTHER