Provider Demographics
NPI:1124425483
Name:HOPE MEDICAL, LLC
Entity type:Organization
Organization Name:HOPE MEDICAL, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SAMUEL
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:678-704-0306
Mailing Address - Street 1:5300 MEMORIAL DR
Mailing Address - Street 2:SUITE 110-112
Mailing Address - City:STONE MOUNTAIN
Mailing Address - State:GA
Mailing Address - Zip Code:30083-3148
Mailing Address - Country:US
Mailing Address - Phone:678-704-0306
Mailing Address - Fax:678-704-0706
Practice Address - Street 1:5300 MEMORIAL DR
Practice Address - Street 2:SUITE 110-112
Practice Address - City:STONE MOUNTAIN
Practice Address - State:GA
Practice Address - Zip Code:30083-3148
Practice Address - Country:US
Practice Address - Phone:678-704-0306
Practice Address - Fax:678-704-0706
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-02
Last Update Date:2014-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA037486207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty