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Organization

PHYNOVA MSO, LLC

Active
Parent organization
PMR HOLDING COMPANY, LLC
Organization subpart
Yes

Provider details

NPI number
Legal business name
PMR HOLDING COMPANY, LLC
Authorized official
LAVERNE W POINDEXTER (CHIEF EXECUTIVE OFFICER)
(770) 270-5229
Entity
Organization

Contact information

Practice address
1718 PEACHTREE ST NW STE 380, ATLANTA, GA 30309-2498
(770) 270-5229
(770) 270-9323
Mailing address
PO BOX 54157, ATLANTA, GA 30308-0157
(770) 270-5229
(770) 270-9323

Taxonomy

Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
208D00000X
General Practice Physician

Other

Enumeration date
08/10/2020
Last updated
08/10/2020
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