Healthcare Provider Details
I. General information
NPI: 1396283859
Provider Name (Legal Business Name): ARILEX MEDICAL SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:
II. Dates (important events)
Enumeration Date: 02/05/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:
III. Provider practice location address
5983 HIGHWAY 53 E STE 100
DAWSONVILLE GA
30534-9512
US
IV. Provider business mailing address
6125 BROADWATER TRL
CUMMING GA
30040-9521
US
V. Phone/Fax
- Phone: 412-477-4493
- Fax: 470-281-5129
- Phone: 412-477-4493
- Fax: 470-281-5129
VI. Provider taxonomy
Scope of Practice (Provider specialty)
| # 1 | |
| Primary Taxonomy | Y |
| Taxonomy Code | 207LA0401X |
| Taxonomy | Addiction Medicine (Anesthesiology) Physician |
| License Number | |
| License Number State | |
VIII. Authorized Official
Name: DR.
GARY
GEORGE
THEOFILIS
Title or Position: PRESIDENT & MEDICAL DIRECTOR
Credential: DO, DABAM, DAAIM
Phone: 412-477-4493