Provider Demographics
NPI:1902261274
Name:COMPLETE HEALTH MEDICAL CENTER
Entity Type:Organization
Organization Name:COMPLETE HEALTH MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:VICTOR
Authorized Official - Middle Name:Y
Authorized Official - Last Name:LESLIE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:404-241-7062
Mailing Address - Street 1:11770 HAYNES BRIDGE RD
Mailing Address - Street 2:STE 205-215
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30009-1966
Mailing Address - Country:US
Mailing Address - Phone:404-241-7062
Mailing Address - Fax:404-243-0357
Practice Address - Street 1:4153 FLAT SHOALS PKWY
Practice Address - Street 2:BLDG A STE 104
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30034-4106
Practice Address - Country:US
Practice Address - Phone:404-241-7062
Practice Address - Fax:404-243-0357
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-30
Last Update Date:2015-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207R00000X
GA074690261QP3300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
No261QP3300XAmbulatory Health Care FacilitiesClinic/CenterPainGroup - Single Specialty