Healthcare Provider Details

I. General information

NPI: 1942541511
Provider Name (Legal Business Name): MEN'S HEALTH GEORGIA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/07/2013
Last Update Date: 01/23/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1557 JANMAR RD
SNELLVILLE GA
30078-5686
US

IV. Provider business mailing address

1557 JANMAR RD
SNELLVILLE GA
30078-5686
US

V. Phone/Fax

Practice location:
  • Phone: 800-999-7693
  • Fax: 404-492-7021
Mailing address:
  • Phone: 800-999-7693
  • Fax: 404-492-7021

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number2013OCC-005544
License Number StateGA

VIII. Authorized Official

Name: DR. JITESH VINOD PATEL
Title or Position: PRESIDENT
Credential: M.D.
Phone: 678-344-8900