Provider Demographics
NPI:1376922278
Name:FOUNDATION HEALTH SERVICES, PLLC
Entity Type:Organization
Organization Name:FOUNDATION HEALTH SERVICES, PLLC
Other - Org Name:FOUNDATION HEALTH URGENT CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:MADILL
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:770-572-1121
Mailing Address - Street 1:5583 BOBBY HICKS HWY STE 205
Mailing Address - Street 2:
Mailing Address - City:GRAY
Mailing Address - State:TN
Mailing Address - Zip Code:37615-3283
Mailing Address - Country:US
Mailing Address - Phone:423-707-2509
Mailing Address - Fax:423-430-6002
Practice Address - Street 1:5583 BOBBY HICKS HWY STE 205
Practice Address - Street 2:
Practice Address - City:GRAY
Practice Address - State:TN
Practice Address - Zip Code:37615-3283
Practice Address - Country:US
Practice Address - Phone:423-707-2509
Practice Address - Fax:423-430-6002
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-26
Last Update Date:2022-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent CareGroup - Multi-Specialty
No111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedicalGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty