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General NPI Number Information
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NPI Number | 1427068188
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Entity Type | Organization
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Legal Business Name | HEALTH E STATION
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Dates
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Enumeration Date | 08/08/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 526 CROSSTOWN RD
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City | PEACHTREE CITY
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State | GA
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Zip | 30269-2916
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Country | US
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Telephone | 770-692-1914
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Fax | 770-692-1919
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Provider Business Mailing Address
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Address Line | 526 CROSSTOWN DR.
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City | PEACHTREE CITY
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State | GA
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Zip | 30269-2916
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Country | US
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Telephone | 770-692-1914
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Fax | 770-692-1919
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Authorized Official
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Title or Position | CHIEF MEDICAL OFFICER
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Name | DR. ELIZABETH N/A NEGA
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Credential | M.D
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Telephone | 770-692-1914
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | 050546
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License Number State | GA
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