Provider Demographics
NPI:1992708929
Name:NOVAMED MANAGEMENT SERVICES LLC
Entity type:Organization
Organization Name:NOVAMED MANAGEMENT SERVICES LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OFFICER AND AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:BOYD
Authorized Official - Last Name:BALDOCK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-234-5954
Mailing Address - Street 1:3200 DOWNWOOD CIR NW
Mailing Address - Street 2:SUITE 200
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30327-1610
Mailing Address - Country:US
Mailing Address - Phone:404-351-1990
Mailing Address - Fax:
Practice Address - Street 1:3200 DOWNWOOD CIR NW
Practice Address - Street 2:STE 200
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30327-1610
Practice Address - Country:US
Practice Address - Phone:404-351-1990
Practice Address - Fax:404-355-8797
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-05-23
Last Update Date:2023-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA060-209261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000890667AMedicaid
GAP00164715OtherRR MEDICARE
490004881OtherRR MEDICARE
GA111017ASCBMedicare PIN
GA111017ASCBMedicare UPIN