PREMISE HEALTH OF GEORGIA MEDICAL P.C. NPI 1891207536

NPI Information

NPI: 1891207536
Provider Name: PREMISE HEALTH OF GEORGIA MEDICAL, P.C.

Doing Business As: HARRISON POULTRY WELLNESS CENTER

Classification: Clinic/Center - 261QM1300X
Entity Type: Organization

Specialization: Multi-Specialty

Address:
107 E STAR ST
BETHLEHEM, GA
ZIP 30620
Phone: (678) 975-3115
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PREMISE HEALTH OF GEORGIA MEDICAL, P.C. is a multi-specialty clinic center in Bethlehem, GA. PREMISE HEALTH OF GEORGIA MEDICAL, P.C. NPI is 1891207536. The provider is registered as an organization entity type.
The provider Is Doing Business As Harrison Poultry Wellness Center.

The provider's business location address is:

107 E STAR ST
BETHLEHEM, GA
ZIP 30620-119
Phone: (678) 975-3115
Fax: (678) 975-3116

The provider's authorized official is Jon Leizman .
The authorized official title is President and has the following contact phone number (216) 479-9063.

The CLIA number assigned to this NPI record is 11D2138820 - physician office with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 11/3/2017 and was last updated on 8/24/2022.

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
1	261QM1300X	Clinic/Center	Multi-Specialty			Yes

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

NPI Synchronization or Removal

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