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General NPI Number Information
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NPI Number | 1750266821
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Entity Type | Organization
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Legal Business Name | EAGLEMD MH SVC LLC
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Dates
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Enumeration Date | 08/07/2025
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Last Update Date | 08/07/2025
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Provider Practice Location Address
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Address Line | 2302 PARKLAKE DR STE# 385
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City | ATLANTA
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State | GA
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Zip | 30345-2896
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Country | US
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Telephone | 678-656-2232
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Fax | 678-623-5662
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Provider Business Mailing Address
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Address Line | 2274 SPENCERS WAY
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City | STONE MOUNTAIN
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State | GA
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Zip | 30087-1247
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Country | US
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Telephone | 678-656-2232
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Fax | 678-623-5662
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Authorized Official
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Title or Position | PSYCHIATRIST
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Name | DR. NURUL I. HOQUE
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Credential | MD
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Telephone | 678-656-2232
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number |
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License Number State |
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