Provider Demographics
NPI:1548616394
Name:BUSINESS & TECHNOLOGY OUTREACH CORPORATION
Entity Type:Organization
Organization Name:BUSINESS & TECHNOLOGY OUTREACH CORPORATION
Other - Org Name:GEORGIA HEALTHCARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO/ADMIN
Authorized Official - Prefix:
Authorized Official - First Name:REGINA
Authorized Official - Middle Name:
Authorized Official - Last Name:FITZGERALD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-961-1997
Mailing Address - Street 1:7130 MOUNT ZION BLVD STE 7
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:GA
Mailing Address - Zip Code:30236-2566
Mailing Address - Country:US
Mailing Address - Phone:770-961-1997
Mailing Address - Fax:
Practice Address - Street 1:7130 MOUNT ZION BLVD STE 7
Practice Address - Street 2:
Practice Address - City:JONESBORO
Practice Address - State:GA
Practice Address - Zip Code:30236-2566
Practice Address - Country:US
Practice Address - Phone:770-961-1997
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:1967
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-05-11
Last Update Date:2016-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QP2300X
GA261QU0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care