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PROVIDENCE HEALTHCARE NPI 1699895961


NPI Information

NPI: 1699895961
Provider Name: PROVIDENCE HEALTHCARE
Classification: Allergy & Immunology - 207KI0005X
Entity Type: Organization

Specialization: Clinical & Laboratory Immunology

Address:
4646 N SHALLOWFORD RD
ATLANTA, GA
ZIP 30338
Phone: (770) 676-6000
Get Directions

PROVIDENCE HEALTHCARE is a clinical and laboratory immunology allergy immunology in Atlanta, GA. The provider is an allergy and immunology physician who specializes in clinical and laboratory immunology disease management. Source: National Uniform Claim Committee, 2022 Additional Resources: A certification was, but is no longer, issued by the American Board of Allergy and Immunology. PROVIDENCE HEALTHCARE NPI is 1699895961. The provider is registered as an organization entity type and is a multiple single specialty group.

The provider's business location address is:

4646 N SHALLOWFORD RD
ATLANTA, GA
ZIP 30338-304
Phone: (770) 676-6000
Fax: (770) 392-9805

The provider's authorized official is Mary Leach .
The authorized official title is Office Manager and has the following contact phone number (770) 676-6000.

The enumeration date for this NPI number is 3/30/2007 and was last updated on 7/21/2022.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.Taxonomy CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
1111N00000XChiropractorCHIR005530GEORGIANo
2171100000XAcupuncturist000186FLORIDANo
3207KI0005XAllergy & ImmunologyClinical & Laboratory ImmunologyGEORGIAYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.Other Provider IdentifierOther Provider Identifier TypeOther Provider Identifier StateOther Provider Identifier Issuer
150014615OTHERGEORGIATAT
2826713OTHERGEORGIABLUECROSS BLUE SHIELD
3D44849OTHERGEORGIAUPIN

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

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