Healthcare Provider Details

I. General information

NPI: 1811367097
Provider Name (Legal Business Name): MEDICAL EXAMS DIRECT INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/01/2015
Last Update Date: 10/01/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3295 RIVER EXCHANGE DR SUITE 584
NORCROSS GA
30092-4241
US

IV. Provider business mailing address

3295 RIVER EXCHANGE DR SUITE 584
NORCROSS GA
30092-4241
US

V. Phone/Fax

Practice location:
  • Phone: 770-559-8739
  • Fax: 888-208-3010
Mailing address:
  • Phone: 770-559-8739
  • Fax: 888-208-3010

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code261QC1500X
TaxonomyCommunity Health Clinic/Center
License Number
License Number StateGA

VIII. Authorized Official

Name: MARGARET SPAIN
Title or Position: ADMINISTRATOR
Credential:
Phone: 678-820-7976