Provider Demographics
NPI:1952927279
Name:TOTAL HEALTH SOLUTIONS MEDICAL CENTER
Entity Type:Organization
Organization Name:TOTAL HEALTH SOLUTIONS MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KATY
Authorized Official - Middle Name:
Authorized Official - Last Name:SUDANO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-751-5700
Mailing Address - Street 1:12220 BIRMINGHAM HWY STE A
Mailing Address - Street 2:
Mailing Address - City:MILTON
Mailing Address - State:GA
Mailing Address - Zip Code:30004-4184
Mailing Address - Country:US
Mailing Address - Phone:770-751-5700
Mailing Address - Fax:
Practice Address - Street 1:12220 BIRMINGHAM HWY STE A
Practice Address - Street 2:
Practice Address - City:MILTON
Practice Address - State:GA
Practice Address - Zip Code:30004-4184
Practice Address - Country:US
Practice Address - Phone:770-751-5700
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-23
Last Update Date:2020-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
208D00000XOtherTAXONOMY - MULTI SPECIALTY & GENERAL PRACTICE