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General NPI Number Information
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NPI Number | 1518438555
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Entity Type | Organization
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Legal Business Name | ZENIA 2 LLC, DBA BRITE LIFE PRIMARY CARE
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Dates
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Enumeration Date | 12/17/2018
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Last Update Date | 12/17/2018
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Provider Practice Location Address
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Address Line | 930 NEW HOPE RD STE 10
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City | LAWRENCEVILLE
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State | GA
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Zip | 30045-3837
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Country | US
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Telephone | 770-214-4902
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Fax |
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Provider Business Mailing Address
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Address Line | 4300 IVY FORK DR
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City | LOGANVILLE
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State | GA
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Zip | 30052-5827
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Country | US
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Telephone | 678-614-1814
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Fax |
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Authorized Official
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Title or Position | CREDENTIAL SPECIALIST
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Name | SHEILA MCCRAY
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Credential |
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Telephone | 678-614-1814
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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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