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General NPI Number Information
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NPI Number | 1356935639
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Entity Type | Organization
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Legal Business Name | MSM HEALTH EQUITY FOR ALL LIVES STUDENT-RUN FREE CLINIC
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Dates
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Enumeration Date | 02/26/2021
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Last Update Date | 03/10/2021
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Provider Practice Location Address
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Address Line | 455 LEE ST, SW
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City | ATLANTA
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State | GA
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Zip | 30310
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Country | US
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Telephone | 404-756-1209
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Fax |
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Provider Business Mailing Address
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Address Line | 720 WESTVIEW DR SW STE 275550
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City | ATLANTA
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State | GA
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Zip | 30310-1458
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Country | US
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Telephone | 404-756-1400
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Fax |
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Authorized Official
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Title or Position | CREDENTIALING MANAGER
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Name | JASMINE BAJNATH
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Credential |
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Telephone | 404-756-1400
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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