Provider Demographics
NPI:1427851708
Name:BADIA HEALTHCARE
Entity type:Organization
Organization Name:BADIA HEALTHCARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPERATIONS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ASHLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:DEFORE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:478-508-3308
Mailing Address - Street 1:2001 MELROSE PL
Mailing Address - Street 2:
Mailing Address - City:KATHLEEN
Mailing Address - State:GA
Mailing Address - Zip Code:31047-2873
Mailing Address - Country:US
Mailing Address - Phone:615-738-6463
Mailing Address - Fax:
Practice Address - Street 1:2001 MELROSE PL
Practice Address - Street 2:
Practice Address - City:KATHLEEN
Practice Address - State:GA
Practice Address - Zip Code:31047-2873
Practice Address - Country:US
Practice Address - Phone:615-738-6463
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-03-31
Last Update Date:2025-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
No305S00000XManaged Care OrganizationsPoint of Service