Provider Demographics
NPI:1508494519
Name:SOLVENT LLC
Entity Type:Organization
Organization Name:SOLVENT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:MELANDY
Authorized Official - Middle Name:
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:478-283-6805
Mailing Address - Street 1:104 BRANDON WAY
Mailing Address - Street 2:
Mailing Address - City:BYRON
Mailing Address - State:GA
Mailing Address - Zip Code:31008-5433
Mailing Address - Country:US
Mailing Address - Phone:478-283-6805
Mailing Address - Fax:
Practice Address - Street 1:104 BRANDON WAY
Practice Address - Street 2:
Practice Address - City:BYRON
Practice Address - State:GA
Practice Address - Zip Code:31008-5433
Practice Address - Country:US
Practice Address - Phone:478-283-6805
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SOLVENT LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-03-27
Last Update Date:2020-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA1245871250Medicaid