=====================================================
General NPI Number Information
=====================================================
NPI Number | 1467276550
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | GO MD USA LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/14/2024
-----------------------------------------------------
Last Update Date | 11/14/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3385 AIRWAYS BLVD STE 201
-----------------------------------------------------
City | MEMPHIS
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 38116-3808
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 833-546-6387
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3385 AIRWAYS BLVD STE 201
-----------------------------------------------------
City | MEMPHIS
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 38116-3808
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 833-546-6387
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | APOLLO ARCALLANA
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 833-546-6387
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QP2300X
-----------------------------------------------------
Taxonomy Name | Primary Care Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------