Preventive Medicine Anti-Aging and Chelation, Inc

Primary specialty

Point of ServiceTaxonomy code 305S00000X

Legal business name

PREVENTIVE MEDICINE ANTI-AGING AND CHELATION, INC

Practice address

148 Cobb Pkwy
Ringgold, GA 30736-8566

Phone

(706) 891-1200

NPI assigned

Feb 3, 2017

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dimitri Loucas

Title

Billing

Phone

(706) 891-1200

Specialties & licenses 1

Addresses

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Tax ID family

Preventive Medicine Anti-Aging and Chelation Inc2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Preventive Medicine Anti-Aging and Chelation Therapy Inc.

  • Point of Service
  • Sandy Springs, GA
  • NPI 1114459096
  NPD tax ID

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1486080000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1486080000000",
    "number": "1255879755",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "148 COBB PKWY",
            "city": "RINGGOLD",
            "state": "GA",
            "postal_code": "307368566",
            "telephone_number": "706-891-1200"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "148 COBB PKWY",
            "city": "RINGGOLD",
            "state": "GA",
            "postal_code": "307368566",
            "telephone_number": "706-891-1200"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PREVENTIVE MEDICINE ANTI-AGING AND CHELATION, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-02-03",
        "last_updated": "2017-02-03",
        "status": "A",
        "authorized_official_last_name": "LOUCAS",
        "authorized_official_first_name": "DIMITRI",
        "authorized_official_title_or_position": "BILLING",
        "authorized_official_telephone_number": "706-891-1200"
    },
    "taxonomies": [
        {
            "code": "305S00000X",
            "taxonomy_group": "",
            "desc": "Point of Service",
            "state": "GA",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Point of Service in Ringgold, GA
• Providers in Ringgold, GA by specialty
• Point of Service in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 3, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.