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NPI Code Detail

MEDICARE: EGLESTON AFFILIATED SERVICES

MEDICARE: EGLESTON AFFILIATED SERVICES
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
1261QU0200XUrgent Care Clinic/Center044-079GA

General Provider Information

NPI Number : 1225102411
Entity Type Code : Organization
Provider Name (Legal Business Name) : EGLESTON AFFILIATED SERVICES
Provider Business Mailing Address
First Line : 1584 TULLIE CIR NE
Second Line :
City : ATLANTA
State : GA
Zip : 30329-2311
Country : US
Telephone Number : 404-785-7928
Fax Number :
Provider Business Practice Location Address
First Line : 2201 MOUNT ZION PKWY
Second Line :
City : MORROW
State : GA
Zip : 30260-3312
Country : US
Telephone Number : 404-785-8660
Fax Number :
Authorized Official
Title or Position : MANAGER, PROVIDER ENROLLMENT
Name : LOUETTA CODY
Credential :
Telephone Number : 404-785-7876
Provider Enumeration Date : 11/20/2006
Last Update Date : 04/03/2023

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Directions to “EGLESTON AFFILIATED SERVICES ” Practice Location

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