Provider Demographics
NPI:1699394825
Name:GUARDION MEDICAL, LLC
Entity Type:Organization
Organization Name:GUARDION MEDICAL, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:WILLETT
Authorized Official - Suffix:
Authorized Official - Credentials:CNIM
Authorized Official - Phone:478-273-3831
Mailing Address - Street 1:624 PLUM ST STE A
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31201-2811
Mailing Address - Country:US
Mailing Address - Phone:478-273-3831
Mailing Address - Fax:855-940-0206
Practice Address - Street 1:624 PLUM ST STE A
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31201-2811
Practice Address - Country:US
Practice Address - Phone:478-273-3831
Practice Address - Fax:855-940-0206
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-04-08
Last Update Date:2022-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246ZE0600XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherElectroneurodiagnosticGroup - Single Specialty