Fidelity Health Care Group, LLC
Clinic/Center in Stockbridge, GA. Organization (NPI-2).
NPI number1174905830
StatusActive
Last updated in NPPESJan 13, 2024
Details
- NPI
- 1174905830
- Entity type
- Organization (NPI-2)
- Legal business name
- Fidelity Health Care Group, LLC
- Organization subpart
- No
- Enumeration date
- Jun 18, 2015
- Certification date
- Jan 13, 2024
- Last updated
- Jan 13, 2024
Medicare and OIG
- Medicare enrolled (PECOS)
- Not in the Medicare enrollment file
- Can order and refer
- Not on the CMS order and referring list
- OIG exclusion list
- This NPI is not listed
CMS and OIG files of November 2026. PECOS lookup · OIG exclusion check
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 261Q00000X | Clinic/Center | 038495 | GA | Yes |
| 101YP2500X | Counselor, Professional | 038495 | GA |
Practice location
950 Eagles Landing Pkwy# 152
Stockbridge, GA 30281-7343
Phone 703-929-8967 · Fax 404-601-8328
Mailing address
950 Eagles Landing Pkwy# 152
Stockbridge, GA 30281-7343
Phone 703-929-8967 · Fax 404-601-8328
Authorized official
John A Glenn
Medical Director
4782908509
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