Provider Demographics
NPI:1679875173
Name:ABUNDANT LIFE HEALTHCARE
Entity type:Organization
Organization Name:ABUNDANT LIFE HEALTHCARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MARC
Authorized Official - Middle Name:
Authorized Official - Last Name:JEAN-GILLES
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:516-473-6846
Mailing Address - Street 1:601 A PROFESSIONAL DR SUITE 370
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30046-7670
Mailing Address - Country:US
Mailing Address - Phone:678-869-5145
Mailing Address - Fax:877-835-9692
Practice Address - Street 1:601 A PROFESSIONAL DR STE 370
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30046-7670
Practice Address - Country:US
Practice Address - Phone:678-869-5145
Practice Address - Fax:877-835-9692
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-03
Last Update Date:2022-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA62720261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center