Healthcare Provider Details

I. General information

NPI: 1821545997
Provider Name (Legal Business Name): CORPORATE HEALTH PARTNERS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/07/2016
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2105 BARRETT PARK DR NW STE106
KENNESAW GA
30144-7080
US

IV. Provider business mailing address

2105 BARRETT PARK DR NW STE106
KENNESAW GA
30144-7080
US

V. Phone/Fax

Practice location:
  • Phone: 675-486-8610
  • Fax: 678-848-6643
Mailing address:
  • Phone: 675-486-8610
  • Fax: 678-486-8610

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2083P0901X
TaxonomyPublic Health & General Preventive Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. JOHN A OBRIEN
Title or Position: CFO
Credential:
Phone: 404-621-5556