Provider Demographics
NPI:1417571175
Name:INFUSIMED, LLC
Entity Type:Organization
Organization Name:INFUSIMED, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ZANDRAETTA
Authorized Official - Middle Name:L
Authorized Official - Last Name:TIMS-COOK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:844-884-9691
Mailing Address - Street 1:3939 LAVISTA RD # E-310
Mailing Address - Street 2:
Mailing Address - City:TUCKER
Mailing Address - State:GA
Mailing Address - Zip Code:30084-5162
Mailing Address - Country:US
Mailing Address - Phone:844-884-9691
Mailing Address - Fax:
Practice Address - Street 1:2193 CASCADE RD SW
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30311-2862
Practice Address - Country:US
Practice Address - Phone:844-884-9691
Practice Address - Fax:404-907-4052
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FAEBRIS MEDICAL & COMMUNITY EDUCATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-05-28
Last Update Date:2020-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003111898Medicaid