Provider Demographics
NPI:1710315080
Name:AXIS HEALTHCARE GROUP LLC
Entity Type:Organization
Organization Name:AXIS HEALTHCARE GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE VICE PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:WALKER
Authorized Official - Suffix:II
Authorized Official - Credentials:
Authorized Official - Phone:202-213-0484
Mailing Address - Street 1:4701 WILLARD AVE
Mailing Address - Street 2:1124
Mailing Address - City:CHEVY CHASE
Mailing Address - State:MD
Mailing Address - Zip Code:20815-4643
Mailing Address - Country:US
Mailing Address - Phone:202-360-4787
Mailing Address - Fax:202-360-4787
Practice Address - Street 1:4701 WILLARD AVE
Practice Address - Street 2:1124
Practice Address - City:CHEVY CHASE
Practice Address - State:MD
Practice Address - Zip Code:20815-4643
Practice Address - Country:US
Practice Address - Phone:202-360-4787
Practice Address - Fax:202-360-4787
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-24
Last Update Date:2013-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty