Provider Demographics
NPI:1811304884
Name:THERADOX
Entity type:Organization
Organization Name:THERADOX
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE
Authorized Official - Prefix:MRS
Authorized Official - First Name:BEVERLY
Authorized Official - Middle Name:
Authorized Official - Last Name:IDRIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-464-8995
Mailing Address - Street 1:2705 CHRUCH STREET
Mailing Address - Street 2:SUITE B
Mailing Address - City:EAST POINT
Mailing Address - State:GA
Mailing Address - Zip Code:30344
Mailing Address - Country:US
Mailing Address - Phone:404-464-8995
Mailing Address - Fax:404-464-8998
Practice Address - Street 1:2705 CHURCH ST
Practice Address - Street 2:SUITE B
Practice Address - City:EAST POINT
Practice Address - State:GA
Practice Address - Zip Code:30344-3209
Practice Address - Country:US
Practice Address - Phone:404-464-8995
Practice Address - Fax:404-464-8998
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-22
Last Update Date:2014-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty