Provider Demographics
NPI:1700276722
Name:AOAPHO, LLC
Entity type:Organization
Organization Name:AOAPHO, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DALE
Authorized Official - Middle Name:
Authorized Official - Last Name:MCCORD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:770-255-7409
Mailing Address - Street 1:75 REMITTANCE DR DEPT 6653
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60675-6653
Mailing Address - Country:US
Mailing Address - Phone:770-745-1070
Mailing Address - Fax:770-217-9946
Practice Address - Street 1:3330 PRESTON RIDGE RD STE 300
Practice Address - Street 2:
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30005-4509
Practice Address - Country:US
Practice Address - Phone:770-745-1070
Practice Address - Fax:770-217-9946
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-29
Last Update Date:2015-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty