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General NPI Number Information
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NPI Number | 1366972523
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Entity Type | Organization
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Legal Business Name | STRAWBRIDGE HEALTH LLC
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Dates
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Enumeration Date | 06/19/2017
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 4150 SNAPFINGER WOODS DR STE 100A
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City | DECATUR
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State | GA
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Zip | 30035-3417
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Country | US
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Telephone | 470-236-8379
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Fax |
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Provider Business Mailing Address
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Address Line | 4150 SNAPFINGER WOODS DR STE 100A
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City | DECATUR
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State | GA
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Zip | 30035-3417
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Country | US
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Telephone | 470-236-8379
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Fax |
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Authorized Official
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Title or Position | PHYSICIAN
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Name | TIFFANY LEE
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Credential | MD
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Telephone | 470-236-8379
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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 | 046882
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License Number State | GA
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