Provider Demographics
NPI:1518586825
Name:EMSITE LLC
Entity Type:Organization
Organization Name:EMSITE LLC
Other - Org Name:EMSITE PREVENTIVE HEALTH
Other - Org Type:Other Name
Authorized Official - Title/Position:MANAGING DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:YVENER
Authorized Official - Middle Name:
Authorized Official - Last Name:LIBERAL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-807-8627
Mailing Address - Street 1:4275 JOHNS CREEK PKWY STE C
Mailing Address - Street 2:
Mailing Address - City:SUWANEE
Mailing Address - State:GA
Mailing Address - Zip Code:30024-9117
Mailing Address - Country:US
Mailing Address - Phone:678-807-8627
Mailing Address - Fax:
Practice Address - Street 1:4275 JOHNS CREEK PKWY
Practice Address - Street 2:SUITE C
Practice Address - City:SUWANEE
Practice Address - State:GA
Practice Address - Zip Code:30024-9117
Practice Address - Country:US
Practice Address - Phone:678-807-8627
Practice Address - Fax:770-234-6650
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:EMSITE LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-04-16
Last Update Date:2020-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty