Ebt Holdings of Georgia Incorporated

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

Legal business name

EBT HOLDINGS OF GEORGIA INCORPORATED

Practice address

1430 Five Forks Trickum Rd Ste 220
Lawrenceville, GA 30044-8183

Phone

(786) 352-7021

Fax

(786) 698-1632

NPI assigned

Jun 7, 2023

Organization subpart

No

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

Authorized official

Name

Enrique Massuet Valdes

Title

Vice President

Phone

(786) 352-7021

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1686096000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1701734400000",
    "number": "1871287250",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1430 FIVE FORKS TRICKUM RD STE 220",
            "city": "LAWRENCEVILLE",
            "state": "GA",
            "postal_code": "300448183",
            "telephone_number": "786-352-7021",
            "fax_number": "786-698-1632"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1430 FIVE FORKS TRICKUM RD STE 220",
            "city": "LAWRENCEVILLE",
            "state": "GA",
            "postal_code": "300448183",
            "telephone_number": "786-352-7021",
            "fax_number": "786-698-1632"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EBT HOLDINGS OF GEORGIA INCORPORATED",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-06-07",
        "last_updated": "2023-12-05",
        "certification_date": "2023-12-05",
        "status": "A",
        "authorized_official_last_name": "MASSUET VALDES",
        "authorized_official_first_name": "ENRIQUE",
        "authorized_official_title_or_position": "VICE PRESIDENT",
        "authorized_official_telephone_number": "786-352-7021"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Eudora Ayi Ebirien-Agana
• Aimee Lynn Eblen, P.T.
• Charlotte Amelia Ebner, D.O.
• Ikechukwu P. Ebo, D.D.S., P.A.
• Sylvia Eboigbe
• Eca Optical, LLC
• Jonathan Alberto Echeverria, PHARMD
• Echho Healthcare Services LLC
• Shanavia Echols
• Shawndra Jovan Echols

• Family Medicine Physician in Lawrenceville, GA
• Providers in Lawrenceville, GA by specialty
• Family Medicine Physician in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 5, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.