Healthcare Provider Details

I. General information

NPI: 1215132725
Provider Name (Legal Business Name): NETPHYSICIAN INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/15/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3039 AMWILER RD SUITE 118
ATLANTA GA
30360-2824
US

IV. Provider business mailing address

5700 LAKE MANOR TRCE
ALPHARETTA GA
30022-2613
US

V. Phone/Fax

Practice location:
  • Phone: 770-326-6143
  • Fax:
Mailing address:
  • Phone: 678-957-0156
  • Fax: 678-935-3994

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207KI0005X
TaxonomyClinical & Laboratory Immunology (Allergy & Immunology) Physician
License NumberGA038561
License Number StateGA

VIII. Authorized Official

Name: SHARON ANN BRUBAKER
Title or Position: VP OWNER
Credential:
Phone: 678-957-0156