Healthcare Provider Details

I. General information

NPI: 1891465175
Provider Name (Legal Business Name): RELIANT BIOMEDICAL GROUP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/17/2021
Last Update Date: 09/17/2021
Certification Date: 09/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1040 W MARIETTA ST NW
ATLANTA GA
30318-5218
US

IV. Provider business mailing address

9942 SE OSPREY POINTE DR
HOBE SOUND FL
33455-3017
US

V. Phone/Fax

Practice location:
  • Phone: 888-588-7356
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QC1500X
TaxonomyCommunity Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: SCOTT KAPPLER
Title or Position: COO
Credential:
Phone: 888-588-7356