Healthcare Provider Details

I. General information

NPI: 1366058034
Provider Name (Legal Business Name): INNOVATE HEALTHCARE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/18/2020
Last Update Date: 09/24/2020
Certification Date: 09/24/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5450 WHITTLESEY BLVD
COLUMBUS GA
31909-2139
US

IV. Provider business mailing address

3589 BARTOWS BRG
POWDER SPRINGS GA
30127-9001
US

V. Phone/Fax

Practice location:
  • Phone: 706-843-4398
  • Fax: 706-723-8671
Mailing address:
  • Phone: 706-842-4398
  • Fax: 706-723-8671

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: RILIWANU ALIU
Title or Position: OWNER
Credential: MD
Phone: 770-865-9610