Healthcare Provider Details

I. General information

NPI: 1689059206
Provider Name (Legal Business Name): GEORGIA MHT LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/24/2015
Last Update Date: 07/24/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1515 HERITAGE DR SUITE 110
MCKINNEY TX
75069-3256
US

IV. Provider business mailing address

1515 HERITAGE DR SUITE 110
MCKINNEY TX
75069-3256
US

V. Phone/Fax

Practice location:
  • Phone: 844-633-4663
  • Fax: 877-489-3949
Mailing address:
  • Phone: 844-633-4663
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: SCOTT POSTLE
Title or Position: OWNER
Credential:
Phone: 844-633-4663