Healthcare Provider Details

I. General information

NPI: 1427851708
Provider Name (Legal Business Name): BADIA HEALTHCARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/31/2025
Last Update Date: 03/31/2025
Certification Date: 03/31/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2001 MELROSE PL
KATHLEEN GA
31047-2873
US

IV. Provider business mailing address

2001 MELROSE PL
KATHLEEN GA
31047-2873
US

V. Phone/Fax

Practice location:
  • Phone: 615-738-6463
  • Fax:
Mailing address:
  • Phone: 615-738-6463
  • 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 Code305S00000X
TaxonomyPoint of Service
License Number
License Number State

VIII. Authorized Official

Name: ASHLEY DEFORE
Title or Position: OPERATIONS MANAGER
Credential:
Phone: 478-508-3308