Healthcare Provider Details

I. General information

NPI: 1336890391
Provider Name (Legal Business Name): ACEEBA HEALTHCARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/11/2022
Last Update Date: 02/03/2022
Certification Date: 02/03/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1006 ARBOR WAY
MCDONOUGH GA
30253-8715
US

IV. Provider business mailing address

100 POSTMASTER DR UNIT 2423
MCDONOUGH GA
30253-2821
US

V. Phone/Fax

Practice location:
  • Phone: 678-365-1611
  • Fax:
Mailing address:
  • Phone: 678-365-1611
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number State

VIII. Authorized Official

Name: NATASHA CARSWELL KELLY
Title or Position: OWNER
Credential:
Phone: 678-365-1611