Provider Demographics
NPI:1154042265
Name:HORMONE AND DIABETIC INFUSION CENTER
Entity type:Organization
Organization Name:HORMONE AND DIABETIC INFUSION CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:ALFERINK
Authorized Official - Suffix:
Authorized Official - Credentials:FNP-C
Authorized Official - Phone:762-220-1962
Mailing Address - Street 1:1129 LAKE OCONEE PKWY STE 104
Mailing Address - Street 2:
Mailing Address - City:EATONTON
Mailing Address - State:GA
Mailing Address - Zip Code:31024-9581
Mailing Address - Country:US
Mailing Address - Phone:762-220-1962
Mailing Address - Fax:762-220-1961
Practice Address - Street 1:1129 LAKE OCONEE PKWY STE 104
Practice Address - Street 2:
Practice Address - City:EATONTON
Practice Address - State:GA
Practice Address - Zip Code:31024-9581
Practice Address - Country:US
Practice Address - Phone:762-220-1962
Practice Address - Fax:762-220-1961
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-07
Last Update Date:2023-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QI0500XAmbulatory Health Care FacilitiesClinic/CenterInfusion Therapy
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center