Basic Information
| Provider Information | |||||||||
| NPI: | 1194433219 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | AYLO HEALTH, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3333 RIVERWOOD PKWY SE STE 250 | ||||||||
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| City: | ATLANTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 303393304 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7709140116 | ||||||||
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| Practice Location | |||||||||
| Address1: | 3758 HIGHWAY 42 STE 200 | ||||||||
| Address2: | |||||||||
| City: | LOCUST GROVE | ||||||||
| State: | GA | ||||||||
| PostalCode: | 302483653 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7709140116 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/08/2022 | ||||||||
| LastUpdateDate: | 11/08/2022 | ||||||||
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| AuthorizedOfficialLastName: | WRIGHT | ||||||||
| AuthorizedOfficialFirstName: | KIM | ||||||||
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| AuthorizedOfficialTitleorPosition: | DIRECTOR OF REVENUE CYCLE | ||||||||
| AuthorizedOfficialTelephone: | 7709140116 | ||||||||
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| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | AYLO HEALTH, LLC | ||||||||
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| NPICertificationDate: | 11/08/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0202X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
No ID Information.