Provider Demographics
NPI:1366058034
Name:INNOVATE HEALTHCARE INC
Entity type:Organization
Organization Name:INNOVATE HEALTHCARE INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RILIWANU
Authorized Official - Middle Name:
Authorized Official - Last Name:ALIU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:770-865-9610
Mailing Address - Street 1:3589 BARTOWS BRG
Mailing Address - Street 2:
Mailing Address - City:POWDER SPRINGS
Mailing Address - State:GA
Mailing Address - Zip Code:30127-9001
Mailing Address - Country:US
Mailing Address - Phone:706-842-4398
Mailing Address - Fax:706-723-8671
Practice Address - Street 1:5450 WHITTLESEY BLVD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31909-2139
Practice Address - Country:US
Practice Address - Phone:706-843-4398
Practice Address - Fax:706-723-8671
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-18
Last Update Date:2020-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Single Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty