PROVIDENCE HEALTHCARE NPI 1699895961

NPI Information

NPI: 1699895961
Provider Name: PROVIDENCE HEALTHCARE
Classification: Allergy & Immunology - 207KI0005X
Specialization: Clinical & Laboratory Immunology
Entity Type: Organization
Address: 4646 N SHALLOWFORD RD
ATLANTA, GA
ZIP 30338
Phone: (770) 676-6000

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NPI Details

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 Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	111N00000X	Chiropractor		CHIR005530	GEORGIA	No
2	171100000X	Acupuncturist		000186	FLORIDA	No
3	207KI0005X	Allergy & Immunology	Clinical & Laboratory Immunology		GEORGIA	Yes

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 Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	50014615	OTHER	GEORGIA	TAT
2	826713	OTHER	GEORGIA	BLUECROSS BLUE SHIELD
3	D44849	OTHER	GEORGIA	UPIN

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: 11/21/2025

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