Provider Demographics
NPI:1902957152
Name:MAXA INTERNAL MEDICINE ASSOCIATES PC
Entity Type:Organization
Organization Name:MAXA INTERNAL MEDICINE ASSOCIATES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:ASHLEIGH
Authorized Official - Middle Name:
Authorized Official - Last Name:MAXA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-597-3180
Mailing Address - Street 1:3505 DULUTH PARK LN
Mailing Address - Street 2:BUILDING 4, STE 400
Mailing Address - City:DULUTH
Mailing Address - State:GA
Mailing Address - Zip Code:30096-3201
Mailing Address - Country:US
Mailing Address - Phone:678-597-3180
Mailing Address - Fax:678-597-3181
Practice Address - Street 1:3505 DULUTH PARK LN
Practice Address - Street 2:BUILDING 4, STE 400
Practice Address - City:DULUTH
Practice Address - State:GA
Practice Address - Zip Code:30096-3201
Practice Address - Country:US
Practice Address - Phone:678-597-3180
Practice Address - Fax:678-597-3181
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-15
Last Update Date:2011-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care