Provider Demographics
NPI:1942768536
Name:SLIIIP MEDICAL GROUP P A
Entity type:Organization
Organization Name:SLIIIP MEDICAL GROUP P A
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:AVINESH
Authorized Official - Middle Name:SINGH
Authorized Official - Last Name:BHAR JASWINDAR SINGH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:478-238-3552
Mailing Address - Street 1:212 GA HIGHWAY 49 N STE 1900
Mailing Address - Street 2:
Mailing Address - City:BYRON
Mailing Address - State:GA
Mailing Address - Zip Code:31008-4059
Mailing Address - Country:US
Mailing Address - Phone:478-238-3552
Mailing Address - Fax:478-259-6170
Practice Address - Street 1:212 GA HIGHWAY 49 N STE 1900
Practice Address - Street 2:
Practice Address - City:BYRON
Practice Address - State:GA
Practice Address - Zip Code:31008-4059
Practice Address - Country:US
Practice Address - Phone:478-238-3552
Practice Address - Fax:478-259-6170
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-04
Last Update Date:2025-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep MedicineGroup - Multi-Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
00000OtherNONE