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ST. JUDE'S INTERNAL MEDICINE LLC NPI 1477863579


NPI Information

NPI: 1477863579
Provider Name: ST. JUDE'S INTERNAL MEDICINE, LLC
Classification: Specialist - 174400000X
Entity Type: Organization

CLIA Number: 11D2010335

Address:
1198 BUCKHEAD XING
STE C
WOODSTOCK, GA
ZIP 30189
Phone: (678) 324-7406
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ST. JUDE'S INTERNAL MEDICINE, LLC is a specialist in Woodstock, GA. The provider is an individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree. ST. JUDE'S INTERNAL MEDICINE, LLC NPI is 1477863579. The provider is registered as an organization entity type and is a single specialty group.

The provider's business location address is:

1198 BUCKHEAD XING
STE C
WOODSTOCK, GA
ZIP 30189-257
Phone: (678) 324-7406
Fax: (770) 627-4322

The provider's authorized official is Osborne F D'souza .
The authorized official title is Provider and has the following contact phone number (678) 324-7406.

The CLIA number assigned to this NPI record is 11D2010335 - physician office with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 10/7/2010 and was last updated on 5/8/2014.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1174400000XSpecialistYes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

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