Provider Demographics
NPI:1184257123
Name:AEGIS HEALTH SERVICES LLC
Entity type:Organization
Organization Name:AEGIS HEALTH SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:NOAH
Authorized Official - Middle Name:
Authorized Official - Last Name:HANSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-805-8093
Mailing Address - Street 1:2060 ENTERPRISE RD
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:GA
Mailing Address - Zip Code:30650-5621
Mailing Address - Country:US
Mailing Address - Phone:410-834-8110
Mailing Address - Fax:512-488-9370
Practice Address - Street 1:2220 SUPERIOR VIA
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44113-2367
Practice Address - Country:US
Practice Address - Phone:888-276-0207
Practice Address - Fax:512-488-9370
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-18
Last Update Date:2023-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty