Provider Demographics
NPI:1679529127
Name:TO YOUR HEALTH MEDICAL & FITNESS, PC
Entity Type:Organization
Organization Name:TO YOUR HEALTH MEDICAL & FITNESS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DIANA
Authorized Official - Middle Name:MARGARET
Authorized Official - Last Name:WHITEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:678-218-0320
Mailing Address - Street 1:6278 LAWRENCEVILLE HWY
Mailing Address - Street 2:SUITE 110
Mailing Address - City:TUCKER
Mailing Address - State:GA
Mailing Address - Zip Code:30084-1881
Mailing Address - Country:US
Mailing Address - Phone:678-218-0320
Mailing Address - Fax:678-218-0322
Practice Address - Street 1:6278 LAWRENCEVILLE HWY
Practice Address - Street 2:SUITE 110
Practice Address - City:TUCKER
Practice Address - State:GA
Practice Address - Zip Code:30084-1881
Practice Address - Country:US
Practice Address - Phone:678-218-0320
Practice Address - Fax:678-218-0322
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA037729208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAGRP7238Medicare ID - Type UnspecifiedTO YOUR HEALTH MED & FIT