Healthcare Provider Details

I. General information

NPI: 1871062489
Provider Name (Legal Business Name): UNDENIABLE HEALTHCARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/13/2018
Last Update Date: 12/31/2023
Certification Date: 12/31/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1280 HIGHWAY 74 S STE 100
PEACHTREE CITY GA
30269-3077
US

IV. Provider business mailing address

1280 HIGHWAY 74 S STE 100
PEACHTREE CITY GA
30269-3077
US

V. Phone/Fax

Practice location:
  • Phone: 678-961-5150
  • Fax: 678-559-0789
Mailing address:
  • Phone: 678-961-5150
  • Fax: 678-559-0789

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP1100X
TaxonomyPodiatric Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. TIE SIMS
Title or Position: CEO
Credential: NP
Phone: 678-961-5150