Provider Demographics
NPI:1881019917
Name:NOVA HEALTHCARE GA, LLC
Entity Type:Organization
Organization Name:NOVA HEALTHCARE GA, LLC
Other - Org Name:NOVA MEDICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:NEER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-880-4400
Mailing Address - Street 1:6213 SKYLINE DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77057-7036
Mailing Address - Country:US
Mailing Address - Phone:713-880-4400
Mailing Address - Fax:
Practice Address - Street 1:6213 SKYLINE DR
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77057-7036
Practice Address - Country:US
Practice Address - Phone:713-880-4400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-26
Last Update Date:2014-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA140104932083X0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational MedicineGroup - Single Specialty