Provider Demographics
NPI:1679181168
Name:GUARDIAN HEALTH GROUP
Entity type:Organization
Organization Name:GUARDIAN HEALTH GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NP
Authorized Official - Prefix:MISS
Authorized Official - First Name:MARIE-ANDREE
Authorized Official - Middle Name:
Authorized Official - Last Name:PARENT
Authorized Official - Suffix:
Authorized Official - Credentials:NURSE PRACTITIONER
Authorized Official - Phone:516-647-1557
Mailing Address - Street 1:4228 1ST AVE STE 1A
Mailing Address - Street 2:
Mailing Address - City:TUCKER
Mailing Address - State:GA
Mailing Address - Zip Code:30084-4426
Mailing Address - Country:US
Mailing Address - Phone:866-939-9929
Mailing Address - Fax:470-761-4181
Practice Address - Street 1:4228 1ST AVE STE 1A
Practice Address - Street 2:
Practice Address - City:TUCKER
Practice Address - State:GA
Practice Address - Zip Code:30084-4426
Practice Address - Country:US
Practice Address - Phone:866-939-9929
Practice Address - Fax:470-761-4181
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-21
Last Update Date:2024-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty