Provider Demographics
NPI:1538343439
Name:TOTAL HEALTH MEDICAL CENTER CORPORATION
Entity type:Organization
Organization Name:TOTAL HEALTH MEDICAL CENTER CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:HARVEY
Authorized Official - Middle Name:B
Authorized Official - Last Name:LESLIE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:404-241-7062
Mailing Address - Street 1:3009 RAINBOW DR
Mailing Address - Street 2:STE.139
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30034-1680
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:30034-1680
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:2007-12-27
Last Update Date:2019-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA027597173000000X, 174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
No173000000XOther Service ProvidersLegal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA6047910001Medicare NSC