Provider Demographics
NPI:1982160735
Name:ASA MED LLC
Entity Type:Organization
Organization Name:ASA MED LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHEETAL
Authorized Official - Middle Name:
Authorized Official - Last Name:MANGALAT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-982-2332
Mailing Address - Street 1:3292 THOMPSON BRIDGE RD STE 371
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30506-1561
Mailing Address - Country:US
Mailing Address - Phone:770-982-2332
Mailing Address - Fax:
Practice Address - Street 1:2295 RONALD REAGAN PKWY
Practice Address - Street 2:
Practice Address - City:SNELLVILLE
Practice Address - State:GA
Practice Address - Zip Code:30078-5698
Practice Address - Country:US
Practice Address - Phone:770-982-2332
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-18
Last Update Date:2019-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty