Provider Demographics
NPI:1750266821
Name:EAGLEMD MH SVC LLC
Entity type:Organization
Organization Name:EAGLEMD MH SVC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHIATRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:NURUL
Authorized Official - Middle Name:I
Authorized Official - Last Name:HOQUE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:678-656-2232
Mailing Address - Street 1:2274 SPENCERS WAY
Mailing Address - Street 2:
Mailing Address - City:STONE MOUNTAIN
Mailing Address - State:GA
Mailing Address - Zip Code:30087-1247
Mailing Address - Country:US
Mailing Address - Phone:678-656-2232
Mailing Address - Fax:678-623-5662
Practice Address - Street 1:2302 PARKLAKE DR STE# 385
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30345-2896
Practice Address - Country:US
Practice Address - Phone:678-656-2232
Practice Address - Fax:678-623-5662
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-08-07
Last Update Date:2025-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)