Provider Demographics
NPI:1598357600
Name:UPWARD HEALTH OF GEORGIA LLC
Entity Type:Organization
Organization Name:UPWARD HEALTH OF GEORGIA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:
Authorized Official - Last Name:MIHALE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:888-985-5455
Mailing Address - Street 1:80 ARKAY DR STE 230
Mailing Address - Street 2:
Mailing Address - City:HAUPPAUGE
Mailing Address - State:NY
Mailing Address - Zip Code:11788-3705
Mailing Address - Country:US
Mailing Address - Phone:888-985-5455
Mailing Address - Fax:
Practice Address - Street 1:512 PETERSON AVE S # 2006
Practice Address - Street 2:
Practice Address - City:DOUGLAS
Practice Address - State:GA
Practice Address - Zip Code:31533-5254
Practice Address - Country:US
Practice Address - Phone:888-985-5455
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-09
Last Update Date:2021-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty