Provider Demographics
NPI:1174732747
Name:COVINGTON ONE MEDICAL,LLC
Entity type:Organization
Organization Name:COVINGTON ONE MEDICAL,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZATION OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:CHANEL
Authorized Official - Middle Name:Y
Authorized Official - Last Name:HUANG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-385-0045
Mailing Address - Street 1:PO BOX 1277
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:GA
Mailing Address - Zip Code:30015-1277
Mailing Address - Country:US
Mailing Address - Phone:678-644-6740
Mailing Address - Fax:
Practice Address - Street 1:1065 ACCESS RD STE B
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:GA
Practice Address - Zip Code:30014-6815
Practice Address - Country:US
Practice Address - Phone:707-385-0045
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-21
Last Update Date:2024-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No261QX0100XAmbulatory Health Care FacilitiesClinic/CenterOccupational Medicine