Provider Demographics
NPI:1174396428
Name:HEALTHYCONNECT ACCUSHIELD OF GEORGIA, LLC
Entity type:Organization
Organization Name:HEALTHYCONNECT ACCUSHIELD OF GEORGIA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMIN
Authorized Official - Prefix:
Authorized Official - First Name:WENDY
Authorized Official - Middle Name:
Authorized Official - Last Name:HUGHES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-325-0523
Mailing Address - Street 1:1325 HIGHWAY 41 S
Mailing Address - Street 2:
Mailing Address - City:FORSYTH
Mailing Address - State:GA
Mailing Address - Zip Code:31029-8824
Mailing Address - Country:US
Mailing Address - Phone:678-325-0523
Mailing Address - Fax:678-820-4097
Practice Address - Street 1:1325 HIGHWAY 41 S
Practice Address - Street 2:
Practice Address - City:FORSYTH
Practice Address - State:GA
Practice Address - Zip Code:31029-8824
Practice Address - Country:US
Practice Address - Phone:678-325-0523
Practice Address - Fax:678-820-4097
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-30
Last Update Date:2023-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult HealthGroup - Multi-Specialty