Organization
EBT HOLDINGS OF GEORGIA INCORPORATED
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ENRIQUE MASSUET VALDES (VICE PRESIDENT)
(786) 352-7021
Entity
Organization
Contact information
Practice address
1430 FIVE FORKS TRICKUM RD STE 220, LAWRENCEVILLE, GA 30044-8183
(786) 352-7021
(786) 698-1632
Mailing address
1430 FIVE FORKS TRICKUM RD STE 220, LAWRENCEVILLE, GA 30044-8183
(786) 352-7021
(786) 698-1632
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Enumeration date
06/07/2023
Last updated
12/05/2023
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