Basic Information
| Provider Information | |||||||||
| NPI: | 1235543620 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PERIMETER PROFESSIONAL SERVICES, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1100 JOHNSON FY RD NE STE 780 | ||||||||
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| City: | ATLANTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 303421743 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4048516378 | ||||||||
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| Practice Location | |||||||||
| Address1: | 3400-A OLD MILTON PKWY | ||||||||
| Address2: | STE 130 | ||||||||
| City: | ALPHARETTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 300054438 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7706648898 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/13/2014 | ||||||||
| LastUpdateDate: | 03/30/2018 | ||||||||
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| AuthorizedOfficialLastName: | HERNANDEZ | ||||||||
| AuthorizedOfficialFirstName: | JORGE | ||||||||
| AuthorizedOfficialMiddleName: | J. | ||||||||
| AuthorizedOfficialTitleorPosition: | VP OF ADMIN SVCS AND CFO | ||||||||
| AuthorizedOfficialTelephone: | 4048516378 | ||||||||
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| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | NORTHSIDE HOSPITAL, INC. | ||||||||
| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.