Provider Demographics
NPI:1699750042
Name:TOM NOGA MD MENTAL HEALTH FOR LIFE PC
Entity type:Organization
Organization Name:TOM NOGA MD MENTAL HEALTH FOR LIFE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER OPERATOR
Authorized Official - Prefix:DR
Authorized Official - First Name:TOM
Authorized Official - Middle Name:
Authorized Official - Last Name:NOGA
Authorized Official - Suffix:
Authorized Official - Credentials:MD MBA
Authorized Official - Phone:404-644-5674
Mailing Address - Street 1:4574 US HIGHWAY 29
Mailing Address - Street 2:STE 101
Mailing Address - City:LILBURN
Mailing Address - State:GA
Mailing Address - Zip Code:30047-3605
Mailing Address - Country:US
Mailing Address - Phone:770-564-0300
Mailing Address - Fax:770-564-0307
Practice Address - Street 1:4574 US HIGHWAY 29
Practice Address - Street 2:STE 101
Practice Address - City:LILBURN
Practice Address - State:GA
Practice Address - Zip Code:30047-3605
Practice Address - Country:US
Practice Address - Phone:770-564-0300
Practice Address - Fax:770-564-0307
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
Not Answered2084P0805XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyGeriatric PsychiatryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00664518AMedicaid
F73217Medicare UPIN
GA26BDJCDMedicare ID - Type Unspecified