Provider Demographics
NPI:1659619088
Name:WHOLECARE MEDICAL, INC
Entity Type:Organization
Organization Name:WHOLECARE MEDICAL, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:BRANDON
Authorized Official - Middle Name:Y
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-277-8988
Mailing Address - Street 1:5390 PEACHTREE INDUSTRIAL BLVD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:NORCROSS
Mailing Address - State:GA
Mailing Address - Zip Code:30071-4715
Mailing Address - Country:US
Mailing Address - Phone:404-277-8988
Mailing Address - Fax:
Practice Address - Street 1:5390 PEACHTREE INDUSTRIAL BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:NORCROSS
Practice Address - State:GA
Practice Address - Zip Code:30071-4715
Practice Address - Country:US
Practice Address - Phone:404-277-8988
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-18
Last Update Date:2013-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty