Basic Information
Provider Information
NPI: 1104380278
EntityType: 2
ReplacementNPI:  
OrganizationName: FLOYD HEALTHCARE MANAGEMENT, INC
LastName:  
FirstName:  
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName: ATRIUM HEALTH FLOYD URGENT CARE ARMUCHEE
OtherOrganizationType: 3
OtherLastName:  
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OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 420 E 2ND AVE STE 103
Address2:  
City: ROME
State: GA
PostalCode: 301613210
CountryCode: US
TelephoneNumber: 7065093000
FaxNumber:  
Practice Location
Address1: 4159 MARTHA BERRY HWY NW
Address2:  
City: ROME
State: GA
PostalCode: 301657705
CountryCode: US
TelephoneNumber: 7062923030
FaxNumber:  
Other Information
ProviderEnumerationDate: 01/23/2019
LastUpdateDate: 08/08/2022
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode:  
AuthorizedOfficialLastName: GORMAN
AuthorizedOfficialFirstName: MATTHEW
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition: VP OF CORPORATE AND NETWORK SERVICE
AuthorizedOfficialTelephone: 7065095000
IsSoleProprietor:  
IsOrganizationSubpart: N
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 08/08/2022

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
332900000X  Y SuppliersNon-Pharmacy Dispensing Site 

No ID Information.


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