=====================================================
General NPI Number Information
=====================================================
NPI Number | 1669803367
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MY MD SOLUTIONS,LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/05/2013
-----------------------------------------------------
Last Update Date | 12/05/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 860 JOHNSON FERRY RD SUITE 140 388
-----------------------------------------------------
City | ATLANTA
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30342-1435
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 678-244-5384
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5825 GLENRIDGE DR BLDG 1 SUITE 208
-----------------------------------------------------
City | ATLANTA
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30328-5387
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 678-244-5384
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | MR. MO SWEENEY
-----------------------------------------------------
Credential | OWNER
-----------------------------------------------------
Telephone | 678-244-5384
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 174400000X
-----------------------------------------------------
Taxonomy Name | Specialist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------