Healthcare Provider Details

I. General information

NPI: 1053073494
Provider Name (Legal Business Name): COVID SOLUTIONS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/13/2021
Last Update Date: 10/13/2021
Certification Date: 10/13/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4151 GRAY HWY
GRAY GA
31032-6101
US

IV. Provider business mailing address

4151 GRAY HWY
GRAY GA
31032-6101
US

V. Phone/Fax

Practice location:
  • Phone: 770-824-4343
  • Fax: 678-519-1089
Mailing address:
  • Phone: 770-824-4343
  • Fax: 678-519-1089

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: JOHN SHIVDAT
Title or Position: ORGANISER
Credential: MD
Phone: 770-824-4343