MEDICARE: ASPIRE FERTILITY GEORGIA, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	009JK	OTHER		OTHER

General Provider Information

NPI Number	:	1225566300
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ASPIRE FERTILITY GEORGIA, LLC

Provider Business Mailing Address
First Line	:	6750 WEST LOOP S STE 395
Second Line	:
City	:	BELLAIRE
State	:	TX
Zip	:	77401-4110
Country	:	US
Telephone Number	:	713-425-3003
Fax Number	:

Provider Business Practice Location Address
First Line	:	6 CONCOURSE PKWY STE 250
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30328-6117
Country	:	US
Telephone Number	:	678-274-6760
Fax Number	:

Authorized Official
Title or Position	:	REV CYCLE MANAGER
Name	:	MRS. TSEY-HAYE Y JOHNSON
Credential	:
Telephone Number	:	713-425-3003

Provider Enumeration Date	:	06/01/2017
Last Update Date	:	06/01/2017

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