Provider Demographics
NPI:1073307641
Name:LADY OF MERCY'S TELEHEALTH SERVICES LLC
Entity type:Organization
Organization Name:LADY OF MERCY'S TELEHEALTH SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:KRYSTAL
Authorized Official - Middle Name:K
Authorized Official - Last Name:PREDEOUX
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-256-3765
Mailing Address - Street 1:5101 LEALAND PLACE LN # 5101
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30044-8305
Mailing Address - Country:US
Mailing Address - Phone:770-256-3765
Mailing Address - Fax:
Practice Address - Street 1:5101 LEALAND PLACE LN # 5101
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30044-8305
Practice Address - Country:US
Practice Address - Phone:770-256-3765
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-04-08
Last Update Date:2025-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care