Healthcare Provider Details

I. General information

NPI: 1831236728
Provider Name (Legal Business Name): INFECTIOUS DISEASE SERVICES OF GEORGIA PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/31/2007
Last Update Date: 06/09/2024
Certification Date: 06/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11660 ALPHARETTA HWY SUITE 430
ROSWELL GA
30076-4943
US

IV. Provider business mailing address

11660 ALPHARETTA HWY SUITE 430
ROSWELL GA
30076-4943
US

V. Phone/Fax

Practice location:
  • Phone: 770-255-1069
  • Fax: 770-255-1075
Mailing address:
  • Phone: 770-255-1069
  • Fax: 770-255-1075

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number
License Number State

VIII. Authorized Official

Name: MS. EMILY CHISM
Title or Position: BILLING DEPARTMENT
Credential:
Phone: 770-255-1069