Healthcare Provider Details

I. General information

NPI: 1952006223
Provider Name (Legal Business Name): INFUSION ASSOCIATES OF GEORGIA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/04/2023
Last Update Date: 04/27/2023
Certification Date: 04/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16 COLLINS DR STE B
CARTERSVILLE GA
30120-2481
US

IV. Provider business mailing address

78 EAGLE GLEN DR NE
CARTERSVILLE GA
30121-8081
US

V. Phone/Fax

Practice location:
  • Phone: 470-421-8638
  • Fax:
Mailing address:
  • Phone: 470-421-8638
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QI0500X
TaxonomyInfusion Therapy Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QR0200X
TaxonomyRadiology Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MS. MITZI COLLINS
Title or Position: AUTHORIZED OFFICIAL
Credential: FNP-C
Phone: 470-421-8638