Provider Demographics
NPI:1972929685
Name:WITHINME MD, ATLANTA
Entity Type:Organization
Organization Name:WITHINME MD, ATLANTA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DERRON
Authorized Official - Middle Name:
Authorized Official - Last Name:SIMON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:804-441-5040
Mailing Address - Street 1:604 GLEN IRIS DR NE
Mailing Address - Street 2:5275 LEE HIGHWAY #201, ARLINGTON, VIRGINIA 22207
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30308-2717
Mailing Address - Country:US
Mailing Address - Phone:404-464-8169
Mailing Address - Fax:404-921-9577
Practice Address - Street 1:604 GLEN IRIS DR NE
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30308-2717
Practice Address - Country:US
Practice Address - Phone:404-464-8169
Practice Address - Fax:404-921-9577
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-06
Last Update Date:2014-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA1366405037261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty