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General NPI Number Information
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NPI Number | 1275048043
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Entity Type | Organization
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Legal Business Name | DIGICOM HEALTHCARE SOLUTION
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Dates
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Enumeration Date | 12/03/2017
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Last Update Date | 06/20/2018
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Provider Practice Location Address
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Address Line | 3330 S COBB DR SE STE B
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City | SMYRNA
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State | GA
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Zip | 30080-4128
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Country | US
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Telephone | 678-556-9478
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Fax |
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Provider Business Mailing Address
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Address Line | 3330 S COBB DR SE STE B
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City | SMYRNA
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State | GA
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Zip | 30080-4128
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Country | US
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Telephone | 770-318-0476
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Fax | 678-298-4503
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Authorized Official
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Title or Position | OWNER
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Name | AVERAL JOHNSON
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Credential | CEO/OWNER
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Telephone | 770-318-0476
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RS0012X
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Taxonomy Name | Sleep Medicine (Internal Medicine) Physician
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License Number | 33177
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number | 33177
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License Number State | GA
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