Provider Demographics
NPI:1134883812
Name:AMPLIFY HEALTH PC
Entity type:Organization
Organization Name:AMPLIFY HEALTH PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:AVI
Authorized Official - Middle Name:Y
Authorized Official - Last Name:FACTOR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-218-5543
Mailing Address - Street 1:1043 EXECUTIVE DR STE 101
Mailing Address - Street 2:
Mailing Address - City:HIXSON
Mailing Address - State:TN
Mailing Address - Zip Code:37343-3998
Mailing Address - Country:US
Mailing Address - Phone:718-218-5543
Mailing Address - Fax:
Practice Address - Street 1:1043 EXECUTIVE DR STE 101102
Practice Address - Street 2:
Practice Address - City:HIXSON
Practice Address - State:TN
Practice Address - Zip Code:37343-3997
Practice Address - Country:US
Practice Address - Phone:423-321-8233
Practice Address - Fax:423-321-8325
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-28
Last Update Date:2022-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty