# MID PHYSICIAN NETWORK (KY), LLC

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** MYIDEALDOCTOR, LLC
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1346783388
- **Legal business name:** MYIDEALDOCTOR, LLC
- **Authorized official:** ADRIAN DAVIS (CEO)
- **Authorized official phone:** (678) 491-2804

## Contact information

- **Practice address:** 5665 NEW NORTHSIDE DR, SUITE 520, ATLANTA, GA 30328-5831
- **Practice address phone:** (678) 491-2804
- **Mailing address:** 5665 NEW NORTHSIDE DR, SUITE 520, ATLANTA, GA 30328-5831
- **Mailing address phone:** (678) 491-2804

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208D00000X | General Practice Physician | — | — | Yes |

## Other

- **Enumeration date:** 11/23/2016
- **Last updated:** 11/23/2016