Provider Demographics
NPI:1689404600
Name:HEALTHY LUC, INC
Entity type:Organization
Organization Name:HEALTHY LUC, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:TAKI
Authorized Official - Middle Name:
Authorized Official - Last Name:MOMIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:404-910-9116
Mailing Address - Street 1:2635 S COBB DR SE
Mailing Address - Street 2:
Mailing Address - City:SMYRNA
Mailing Address - State:GA
Mailing Address - Zip Code:30080-1845
Mailing Address - Country:US
Mailing Address - Phone:404-910-9116
Mailing Address - Fax:470-781-2674
Practice Address - Street 1:2635 S COBB DR SE
Practice Address - Street 2:
Practice Address - City:SMYRNA
Practice Address - State:GA
Practice Address - Zip Code:30080-1845
Practice Address - Country:US
Practice Address - Phone:404-910-9116
Practice Address - Fax:470-781-2674
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-05
Last Update Date:2024-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care