Provider Demographics
NPI:1740561125
Name:JBLB HOLDINGS, LLC
Entity Type:Organization
Organization Name:JBLB HOLDINGS, LLC
Other - Org Name:PROMEDCARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:BERBERIAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:404-574-1945
Mailing Address - Street 1:8343 ROSWELL RD # 283
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30350-2810
Mailing Address - Country:US
Mailing Address - Phone:404-574-1945
Mailing Address - Fax:800-809-6184
Practice Address - Street 1:400 PERIMETER CENTER TER NORTH
Practice Address - Street 2:SUITE 900
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30346
Practice Address - Country:US
Practice Address - Phone:404-574-1945
Practice Address - Fax:800-809-6184
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-30
Last Update Date:2011-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH7626204R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes204R00000XAllopathic & Osteopathic PhysiciansElectrodiagnostic MedicineGroup - Single Specialty