Provider Demographics
NPI:1669848388
Name:MIDWAY HEALTHCARE LLC
Entity Type:Organization
Organization Name:MIDWAY HEALTHCARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:TREASURER
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:L
Authorized Official - Last Name:DORGAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-667-0099
Mailing Address - Street 1:4914 ATLANTA HWY
Mailing Address - Street 2:
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30004-2921
Mailing Address - Country:US
Mailing Address - Phone:770-667-0099
Mailing Address - Fax:770-667-0092
Practice Address - Street 1:4914 ATLANTA HWY
Practice Address - Street 2:
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30004-2921
Practice Address - Country:US
Practice Address - Phone:770-667-0099
Practice Address - Fax:770-667-0092
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-17
Last Update Date:2015-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
No111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty