Provider Demographics
NPI:1285193474
Name:1ST CHOICE TELEMEDICINE LLC
Entity Type:Organization
Organization Name:1ST CHOICE TELEMEDICINE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:BENNIE
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:JR
Authorized Official - Credentials:DO
Authorized Official - Phone:229-395-1253
Mailing Address - Street 1:1500 ROCK QUARRY RD
Mailing Address - Street 2:
Mailing Address - City:STOCKBRIDGE
Mailing Address - State:GA
Mailing Address - Zip Code:30281-5047
Mailing Address - Country:US
Mailing Address - Phone:678-722-5778
Mailing Address - Fax:
Practice Address - Street 1:1500 ROCK QUARRY RD
Practice Address - Street 2:
Practice Address - City:STOCKBRIDGE
Practice Address - State:GA
Practice Address - Zip Code:30281-5047
Practice Address - Country:US
Practice Address - Phone:678-722-5778
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-18
Last Update Date:2023-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003139672CMedicaid