Provider Demographics
NPI:1790105740
Name:CHIMEDICAL DIAGNOSTICS, LLC
Entity Type:Organization
Organization Name:CHIMEDICAL DIAGNOSTICS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:
Authorized Official - Last Name:HUMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:214-619-2300
Mailing Address - Street 1:PO BOX 1611
Mailing Address - Street 2:
Mailing Address - City:PHENIX CITY
Mailing Address - State:AL
Mailing Address - Zip Code:36868-1611
Mailing Address - Country:US
Mailing Address - Phone:877-298-7705
Mailing Address - Fax:866-837-9033
Practice Address - Street 1:541 FOREST PKWY
Practice Address - Street 2:SUITE #14
Practice Address - City:FOREST PARK
Practice Address - State:GA
Practice Address - Zip Code:30297-6144
Practice Address - Country:US
Practice Address - Phone:877-298-7705
Practice Address - Fax:866-837-9033
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-17
Last Update Date:2014-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA4974111N00000X
111N00000X
GA056072208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
No111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty