Provider Demographics
NPI:1467762328
Name:XENON HEALTH OF GEORGIA LLC
Entity Type:Organization
Organization Name:XENON HEALTH OF GEORGIA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:HAROON
Authorized Official - Middle Name:W
Authorized Official - Last Name:CHAUDHRY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:917-621-6854
Mailing Address - Street 1:11 EAST 29TH STREET
Mailing Address - Street 2:#21A
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10016-7516
Mailing Address - Country:US
Mailing Address - Phone:917-621-6854
Mailing Address - Fax:646-304-1681
Practice Address - Street 1:1555 BRAMPTON AVENUE
Practice Address - Street 2:
Practice Address - City:STATESBORO
Practice Address - State:GA
Practice Address - Zip Code:30458-0856
Practice Address - Country:US
Practice Address - Phone:912-681-2007
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:XENON HEALTH LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-10-13
Last Update Date:2010-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty