Provider Demographics
NPI:1679984058
Name:PRE DIABETES PHYSICIAN SERVICES INC
Entity type:Organization
Organization Name:PRE DIABETES PHYSICIAN SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:RANDY
Authorized Official - Middle Name:
Authorized Official - Last Name:MARFIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:512-623-4919
Mailing Address - Street 1:3721 EXECUTIVE CENTER DR STE 160
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78731-1607
Mailing Address - Country:US
Mailing Address - Phone:512-623-4900
Mailing Address - Fax:
Practice Address - Street 1:3280 HOWELL MILL RD NW STE 204
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30327-4100
Practice Address - Country:US
Practice Address - Phone:512-623-4900
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-19
Last Update Date:2014-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA34870174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty