Provider Demographics
NPI:1194088906
Name:SNUPPY, INC.
Entity type:Organization
Organization Name:SNUPPY, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SHAWN
Authorized Official - Middle Name:S
Authorized Official - Last Name:KIM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:770-864-5510
Mailing Address - Street 1:3473 SATELLITE BLVD
Mailing Address - Street 2:STE 108 N
Mailing Address - City:DULUTH
Mailing Address - State:GA
Mailing Address - Zip Code:30096-8690
Mailing Address - Country:US
Mailing Address - Phone:770-864-5510
Mailing Address - Fax:770-864-5398
Practice Address - Street 1:3473 SATELLITE BLVD
Practice Address - Street 2:STE 108 N
Practice Address - City:DULUTH
Practice Address - State:GA
Practice Address - Zip Code:30096-8690
Practice Address - Country:US
Practice Address - Phone:770-864-5510
Practice Address - Fax:770-864-5398
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-18
Last Update Date:2012-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA60393261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care