Provider Demographics
NPI:1407544216
Name:ANYTIME MD INTERNAL MEDICINE AND PHYSICAL THERAPY LLC
Entity Type:Organization
Organization Name:ANYTIME MD INTERNAL MEDICINE AND PHYSICAL THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:EDJUA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:530-848-5863
Mailing Address - Street 1:4898 AUSTELL RD STE B
Mailing Address - Street 2:
Mailing Address - City:AUSTELL
Mailing Address - State:GA
Mailing Address - Zip Code:30106-2055
Mailing Address - Country:US
Mailing Address - Phone:770-675-6149
Mailing Address - Fax:770-635-8017
Practice Address - Street 1:4898 AUSTELL RD STE B
Practice Address - Street 2:
Practice Address - City:AUSTELL
Practice Address - State:GA
Practice Address - Zip Code:30106-2055
Practice Address - Country:US
Practice Address - Phone:770-675-6149
Practice Address - Fax:770-635-8017
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-28
Last Update Date:2023-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
No261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy