Provider Demographics
NPI:1558117705
Name:HEALTHPLACE LLC
Entity type:Organization
Organization Name:HEALTHPLACE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:
Authorized Official - Last Name:OBUBA
Authorized Official - Suffix:
Authorized Official - Credentials:FNP,PMHNP
Authorized Official - Phone:843-683-0248
Mailing Address - Street 1:3459 ACWORTH DUE WEST ROAD ,BUILDING 300 SUITE 321
Mailing Address - Street 2:
Mailing Address - City:ACWORTH
Mailing Address - State:GA
Mailing Address - Zip Code:30101
Mailing Address - Country:US
Mailing Address - Phone:843-683-0248
Mailing Address - Fax:
Practice Address - Street 1:3459 ACWORTH DUE WEST ROAD ,BUILDING 300 SUITE 321
Practice Address - Street 2:
Practice Address - City:ACWORTH
Practice Address - State:GA
Practice Address - Zip Code:30101
Practice Address - Country:US
Practice Address - Phone:843-683-0248
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-29
Last Update Date:2024-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care