Provider Demographics
NPI:1568849313
Name:MYHEALTH MEDICAL ASSOCIATION
Entity Type:Organization
Organization Name:MYHEALTH MEDICAL ASSOCIATION
Other - Org Name:MYHEALTH SCHOOL BASED MEDICAL CENTERS
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LORETTA
Authorized Official - Middle Name:
Authorized Official - Last Name:FITZPATRICK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:888-887-6994
Mailing Address - Street 1:4232 DEFOORS FARM TRL
Mailing Address - Street 2:
Mailing Address - City:POWDER SPRINGS
Mailing Address - State:GA
Mailing Address - Zip Code:30127-4067
Mailing Address - Country:US
Mailing Address - Phone:888-887-6994
Mailing Address - Fax:770-319-1019
Practice Address - Street 1:3900 SE 38TH AVE
Practice Address - Street 2:
Practice Address - City:STARKE
Practice Address - State:FL
Practice Address - Zip Code:32091
Practice Address - Country:US
Practice Address - Phone:888-887-6994
Practice Address - Fax:770-319-1019
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-30
Last Update Date:2015-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes364SF0001XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistFamily HealthGroup - Single Specialty