Provider Demographics
NPI:1548028012
Name:THEADVANCEDMED LLC
Entity type:Organization
Organization Name:THEADVANCEDMED LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:ONYEBUCHI
Authorized Official - Middle Name:
Authorized Official - Last Name:NWAOKOLO
Authorized Official - Suffix:
Authorized Official - Credentials:DNP
Authorized Official - Phone:404-706-6371
Mailing Address - Street 1:1012 SPANIEL TER
Mailing Address - Street 2:
Mailing Address - City:HAMPTON
Mailing Address - State:GA
Mailing Address - Zip Code:30228-5951
Mailing Address - Country:US
Mailing Address - Phone:404-218-8934
Mailing Address - Fax:
Practice Address - Street 1:1505 PENNSYLVANIA AVE
Practice Address - Street 2:
Practice Address - City:MCDONOUGH
Practice Address - State:GA
Practice Address - Zip Code:30253-9114
Practice Address - Country:US
Practice Address - Phone:404-706-6371
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-11
Last Update Date:2024-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-SpecialtyGroup - Multi-Specialty
No207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction MedicineGroup - Multi-Specialty
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary CareGroup - Multi-Specialty