Provider Demographics
NPI:1063947877
Name:RADIANT HEALTH FAMILY MEDICAL CENTER
Entity type:Organization
Organization Name:RADIANT HEALTH FAMILY MEDICAL CENTER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:NEVORN
Authorized Official - Middle Name:K
Authorized Official - Last Name:ASKARI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:404-678-3351
Mailing Address - Street 1:540 FAYETTEVILLE RD SE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30316-2306
Mailing Address - Country:US
Mailing Address - Phone:404-687-3351
Mailing Address - Fax:404-678-3357
Practice Address - Street 1:540 FAYETTEVILLE RD SE
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30316-2306
Practice Address - Country:US
Practice Address - Phone:494-687-3351
Practice Address - Fax:404-687-3357
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-29
Last Update Date:2017-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service