Provider Demographics
NPI:1679181168
Name:GUARDIAN HEALTH GROUP
Entity Type:Organization
Organization Name:GUARDIAN HEALTH GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NP
Authorized Official - Prefix:MISS
Authorized Official - First Name:MARIE-ANDREE
Authorized Official - Middle Name:
Authorized Official - Last Name:PARENT
Authorized Official - Suffix:
Authorized Official - Credentials:NURSE PRACTITIONER
Authorized Official - Phone:516-647-1557
Mailing Address - Street 1:6296 CHEATHAM LAKE DR NW
Mailing Address - Street 2:
Mailing Address - City:ACWORTH
Mailing Address - State:GA
Mailing Address - Zip Code:30101-7642
Mailing Address - Country:US
Mailing Address - Phone:516-647-1557
Mailing Address - Fax:
Practice Address - Street 1:6296 CHEATHAM LAKE DR NW
Practice Address - Street 2:
Practice Address - City:ACWORTH
Practice Address - State:GA
Practice Address - Zip Code:30101-7642
Practice Address - Country:US
Practice Address - Phone:516-647-1557
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-21
Last Update Date:2021-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty