Provider Demographics
NPI:1447053202
Name:CITADEL-IG
Entity type:Organization
Organization Name:CITADEL-IG
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CONSULTANT
Authorized Official - Prefix:
Authorized Official - First Name:ZENNET
Authorized Official - Middle Name:
Authorized Official - Last Name:WHEATCROFT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:512-337-3809
Mailing Address - Street 1:275 ECHOLS WAY
Mailing Address - Street 2:
Mailing Address - City:ACWORTH
Mailing Address - State:GA
Mailing Address - Zip Code:30101-2738
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:275 ECHOLS WAY
Practice Address - Street 2:
Practice Address - City:ACWORTH
Practice Address - State:GA
Practice Address - Zip Code:30101-2738
Practice Address - Country:US
Practice Address - Phone:347-239-9983
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-03-28
Last Update Date:2025-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes247000000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Health InformationGroup - Single Specialty