Provider Demographics
NPI:1003103243
Name:ASPEN MEDICAL ASSOCIATES, INC.
Entity type:Organization
Organization Name:ASPEN MEDICAL ASSOCIATES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:S.
Authorized Official - Middle Name:GLENN
Authorized Official - Last Name:KNOWLES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-652-6928
Mailing Address - Street 1:10030 NORMANDY LN
Mailing Address - Street 2:
Mailing Address - City:SUWANEE
Mailing Address - State:GA
Mailing Address - Zip Code:30024-5389
Mailing Address - Country:US
Mailing Address - Phone:855-772-7736
Mailing Address - Fax:678-341-7111
Practice Address - Street 1:10030 NORMANDY LN
Practice Address - Street 2:
Practice Address - City:SUWANEE
Practice Address - State:GA
Practice Address - Zip Code:30024-5389
Practice Address - Country:US
Practice Address - Phone:855-772-7736
Practice Address - Fax:678-341-7111
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-08
Last Update Date:2011-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies