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General NPI Number Information
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NPI Number | 1679708838
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Entity Type | Organization
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Legal Business Name | MEGAREGIONSHEALTHCARESERVICES
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Dates
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Enumeration Date | 05/18/2009
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Last Update Date | 05/18/2009
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Provider Practice Location Address
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Address Line | 115 LLOYD AVE SUITE 105
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City | TYRONE
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State | GA
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Zip | 30290-2126
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Country | US
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Telephone | 770-487-8766
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Fax |
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Provider Business Mailing Address
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Address Line | 230 PERRY CREEK DR
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City | FAYETTEVILLE
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State | GA
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Zip | 30215-2009
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Country | US
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Telephone | 678-817-1096
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Fax |
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Authorized Official
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Title or Position | CERTIFIED SHOEFITTER
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Name | MRS. KATHY SIMPSON
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Credential | CERTIFIED SHOEFITTER
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Telephone | 770-487-8766
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 302R00000X
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Taxonomy Name | Health Maintenance Organization
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License Number |
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License Number State |
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