| Custom Healthcare Llc | |
|
1540 Gober Rd Bishop GA 30621-1685 | |
| (706) 207-1039 | |
| Not Available |
| Full Name | Custom Healthcare Llc |
|---|---|
| Speciality | Clinic/center - Multi-specialty |
| Location | 1540 Gober Rd, Bishop, Georgia |
| Authorized Official Name and Position | Troy Allen Heidesch (CEO/ PROVIDER) |
| Authorized Official Contact | 7062071039 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Custom Healthcare Llc 1540 Gober Rd Bishop GA 30621-1685 Ph: (706) 207-1039 | Custom Healthcare Llc 1540 Gober Rd Bishop GA 30621-1685 Ph: (706) 207-1039 |
| NPI Number | 1316268105 |
|---|---|
| Provider Enumeration Date | 06/16/2010 |
| Last Update Date | 06/16/2010 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1316268105 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM1300X | Clinic/center - Multi-specialty | (* (Not Available)) | Primary |