MEDICARE: RADIANT HEALTH FAMILY MEDICAL CENTER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QH0100X	Health Service Clinic/Center

General Provider Information

NPI Number	:	1063947877
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RADIANT HEALTH FAMILY MEDICAL CENTER

Provider Business Mailing Address
First Line	:	540 FAYETTEVILLE RD SE
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30316-2306
Country	:	US
Telephone Number	:	404-687-3351
Fax Number	:	404-678-3357

Provider Business Practice Location Address
First Line	:	540 FAYETTEVILLE RD SE
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30316-2306
Country	:	US
Telephone Number	:	494-687-3351
Fax Number	:	404-687-3357

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MS. NEVORN K ASKARI
Credential	:	M.D.
Telephone Number	:	404-678-3351

Provider Enumeration Date	:	04/29/2017
Last Update Date	:	04/29/2017

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