Provider Demographics
NPI:1831553163
Name:CENTRESPRING MD
Entity type:Organization
Organization Name:CENTRESPRING MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER
Authorized Official - Prefix:
Authorized Official - First Name:TASNEEM
Authorized Official - Middle Name:
Authorized Official - Last Name:BHATIA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:404-814-9808
Mailing Address - Street 1:1401 DRESDEN DR NE
Mailing Address - Street 2:
Mailing Address - City:BROOKHAVEN
Mailing Address - State:GA
Mailing Address - Zip Code:30319-3579
Mailing Address - Country:US
Mailing Address - Phone:404-814-9808
Mailing Address - Fax:404-814-6086
Practice Address - Street 1:1401 DRESDEN DR NE
Practice Address - Street 2:
Practice Address - City:BROOKHAVEN
Practice Address - State:GA
Practice Address - Zip Code:30319-3579
Practice Address - Country:US
Practice Address - Phone:404-814-9808
Practice Address - Fax:404-814-6086
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-13
Last Update Date:2016-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA1881790079Medicare NSC
GA1790199172Medicare NSC
GA1932535895Medicare NSC
GA1306238738Medicare NSC
GA1932213154Medicare NSC