Provider Demographics
NPI:1104592484
Name:STANDARDCARE, LLC
Entity type:Organization
Organization Name:STANDARDCARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BABATUNDE
Authorized Official - Middle Name:
Authorized Official - Last Name:EDUN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-710-9796
Mailing Address - Street 1:1314 HARRIS WAY
Mailing Address - Street 2:
Mailing Address - City:BROOKHAVEN
Mailing Address - State:GA
Mailing Address - Zip Code:30319-3817
Mailing Address - Country:US
Mailing Address - Phone:718-710-9796
Mailing Address - Fax:
Practice Address - Street 1:1314 HARRIS WAY
Practice Address - Street 2:
Practice Address - City:BROOKHAVEN
Practice Address - State:GA
Practice Address - Zip Code:30319-3817
Practice Address - Country:US
Practice Address - Phone:718-710-9796
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-18
Last Update Date:2021-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care MedicineGroup - Multi-Specialty
No207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious DiseaseGroup - Multi-Specialty