Provider Demographics
NPI:1841876992
Name:SYNERGISTIX UNIVERSAL LLC
Entity type:Organization
Organization Name:SYNERGISTIX UNIVERSAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:ALEXCIUS
Authorized Official - Middle Name:
Authorized Official - Last Name:BRANCH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:901-606-7966
Mailing Address - Street 1:3522 HABERSHAM AT NORTHLAKE STE B
Mailing Address - Street 2:
Mailing Address - City:TUCKER
Mailing Address - State:GA
Mailing Address - Zip Code:30084-4009
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3522 HABERSHAM AT NORTHLAKE STE B
Practice Address - Street 2:
Practice Address - City:TUCKER
Practice Address - State:GA
Practice Address - Zip Code:30084-4009
Practice Address - Country:US
Practice Address - Phone:901-606-7966
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-19
Last Update Date:2021-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity HealthGroup - Multi-Specialty
No172V00000XOther Service ProvidersCommunity Health WorkerGroup - Multi-Specialty
No261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA813319OtherCOMMUNITY HEALTH/MULTI-SERVICE
GA624120OtherCOMMUNITY HEALTH/MULTI-SERVICE