Provider Demographics
NPI:1710090139
Name:NETWORK MEDICAL PROVIDERS
Entity Type:Organization
Organization Name:NETWORK MEDICAL PROVIDERS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LAURIE
Authorized Official - Middle Name:
Authorized Official - Last Name:RICHEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-501-7925
Mailing Address - Street 1:PO BOX 102846
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30368-2846
Mailing Address - Country:US
Mailing Address - Phone:404-501-7925
Mailing Address - Fax:404-501-6638
Practice Address - Street 1:450 N CANDLER ST
Practice Address - Street 2:6TH FLOOR
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30030-2626
Practice Address - Country:US
Practice Address - Phone:404-501-7925
Practice Address - Fax:404-501-6638
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-17
Last Update Date:2007-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CC3738OtherRR MEDICARE GROUP