PROVIDENCE HEALTHCARE (NPI# 1699895961) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1699895961 |
| Entity Type | Organization |
| Organization Name | PROVIDENCE HEALTHCARE |
| Practice Address |
4646 N Shallowford Rd Atlanta GA 30338-6304 |
| Practice Telephone | 7706766000 |
| Practice Fax Number | 7703929805 |
| Mailing Telephone | 7706766000 |
| Mailing Fax Number | 7703929805 |
| Enumeration Date | 2007-03-30 |
| Last Update Date | 2008-04-20 |
| Authorized Official Name | MRS. MARY LEACH (OFFICE MANAGER) |
| Authorized Official Telephone | 7706766000 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 111N00000X | Chiropractor | CHIR005530 | GA | Chiropractic Providers |
| N | 171100000X | Acupuncturist | 000186 | FL | Other Service Providers |
| Y | 207KI0005X |
Allergy & Immunology Specialization: Clinical & Laboratory Immunology |
========= | GA | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| GA | BLUECROSS BLUE SHIELD | 826713 | 01 |
| GA | UPIN | D44849 | 01 |
| GA | TAT | 50014615 | 01 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1770856072 | Providence Healthcare | Home Health | 8505 Nw 74th St, Suite B, Miami, FL 33166-2327 | 2012-02-16 |
| 1720279953 | Providence Healthcare | General Acute Care Hospital | 1015 E D St, Deer Park, WA 99006-5067 | 2007-08-05 |
| 1174692289 | Providence Healthcare | Assisted Living Facility | 34 E 8th Ave, Spokane, WA 99202-7210 | 2006-11-06 |
| 1194917849 | Providence Healthcare | General Acute Care Hospital | 101 W 8th Ave, Spokane, WA 99204-2307 | 2007-08-16 |
| 1215128277 | Providence Healthcare | General Acute Care Hospital | 101 W 8th Ave, Spokane, WA 99204-2307 | 2007-08-06 |
| 1588855548 | Providence Healthcare | General Acute Care Hospital | 500 E Webster Ave, Chewelah, WA 99109-9523 | 2007-08-06 |
| 1417148461 | Providence Healthcare | General Acute Care Hospital | 1015 E D St, Deer Park, WA 99006-5067 | 2007-08-06 |
| 1225229289 | Providence Healthcare | General Acute Care Hospital | 500 E Webster Ave, Chewelah, WA 99109-9523 | 2007-08-06 |
| 1952592917 | Providence Healthcare | General Acute Care Hospital | 5633 N Lidgerwood St, Spokane, WA 99208-1224 | 2007-08-06 |
| 1861683823 | Providence Healthcare | General Acute Care Hospital | 5633 N Lidgerwood St, Spokane, WA 99208-1224 | 2007-08-06 |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| Colorado Business Entities | Providence Healthcare LLC | 4702 Ardley Drive, Colorado Springs, CO 80922 |
| Oklahoma Business Registrations | PROVIDENCE HEALTHCARE MANAGEMENT, LLC | 202 S Main, Po Box 1009, Gore, OK 74435 |
| System for Award Management (SAM) Entities | PROVIDENCE HEALTHCARE OF MS, LLC | 118 Levon Owens Dr, Terry, MS 39170-9696 |
| Street Address |
4646 N SHALLOWFORD RD |
| City | ATLANTA |
| State | GA |
| Zip Code | 30338-6304 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1114553278 | Mallory Howe | Naturopath | 4646 N Shallowford Rd, Atlanta, GA 30338-6308 | 2020-03-19 |
| 1548896780 | Jenna Davis | Naturopath | 4646 N Shallowford Rd, Atlanta, GA 30338-6308 | 2020-03-19 |
| 1881220010 | Taylor Lee Howell | Naturopath | 4646 N Shallowford Rd, Atlanta, GA 30338-6308 | 2020-03-19 |
| 1558997791 | Megan Marie Borreson | Naturopath | 4646 N Shallowford Rd, Atlanta, GA 30338-6308 | 2020-03-19 |
| 1942846464 | Katelyn E Atwell | Health Educator | 4646 N Shallowford Rd, Atlanta, GA 30338-6308 | 2019-11-19 |
| 1992347587 | Regenerative Medical Center, PC | Family Medicine | 4646 N Shallowford Rd, Atlanta, GA 30338-6308 | 2019-10-15 |
| 1255973046 | Amy Tarquini | Naturopath | 4646 N Shallowford Rd, Atlanta, GA 30338-6308 | 2019-10-13 |
| 1407321334 | Adelena Marie Izold | Naturopath | 4646 N Shallowford Rd, Atlanta, GA 30338-6308 | 2018-10-08 |
| 1437688355 | Loren Kennedy Psalidas | Dietitian, Registered | 4646 N Shallowford Rd, Atlanta, GA 30338-6308 | 2017-06-05 |
| 1295181261 | Progressive Healthcare & Diagnostics, LLC | General Practice | 4646 N Shallowford Rd, Atlanta, GA 30338-6308 | 2016-05-10 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1629606264 | Jasmine Donesha Shackelford | Student in an Organized Health Care Education/Training Program | Emory Family Medicine, 4500 North Shallowford Road, Atlanta, GA 30338 | 2020-03-30 |
| 1558907774 | Brianna Harding | Pharmacist | 4608 Devonshire Road, Dunwoody, GA 30338 | 2019-11-22 |
| 1194382135 | Kadan Corporation | In Home Supportive Care | 1848 Independence Square, Suite A, Dunwoody, GA 30338 | 2019-05-24 |
| 1144789553 | Carla Fabiola Nunez | Dentist | 5200 Roberts Dr, Atlanta, GA 30338 | 2019-03-15 |
| 1861978793 | Uhs of Peachford Lp | Pharmacy | 2150 Peachford Rd Ste D, Atlanta, GA 30338 | 2018-07-13 |
| 1275047474 | Mary Rose Ziemba | Physical Therapist | 4516 Chamblee Dunwoody Rd # 22, Dunwoody, GA 30338 | 2017-11-27 |
| 1992223531 | Joel Moorhead | Physical Medicine & Rehabilitation | 1521 Eidson Hall Drive, Dunwoody, GA 30338 | 2017-09-05 |
| 1336667997 | Absolute Holistic Medicine | Clinic/Center | 1868 Independence Sq, Suite A, Atlanta, GA 30338 | 2017-09-05 |
| 1164947115 | Modern Dermatology Atlanta | Dermatology | 5696 Whitehall Walk, Dunwoody, GA 30338 | 2017-08-11 |
| 1366972150 | A Caring Approach To Home Health Services Inc. | In Home Supportive Care | 200 Ashford Center North, Suite 370, Atlanta, GA 30338 | 2017-06-14 |
| Find all providers in zip 30338 | ||||
| Taxonomy Code | 207KI0005X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Allergy & Immunology |
| Specialization | Clinical & Laboratory Immunology |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1215132725 | Netphysician Inc | Allergy & Immunology | 3039 Amwiler Rd, Suite 118, Atlanta, GA 30360-2824 | 2007-06-15 |
| 1174513089 | Michael Wayne Brooks | Allergy & Immunology | 868 York Ave Sw, Atlanta, GA 30310-2750 | 2005-10-24 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1013444645 | Drow-optimum Multispecialty | Allergy & Immunology | 3009 Rainbow Dr Ste 139d, Decatur, GA 30034-1640 | 2017-05-14 |
| 1386918258 | Elizabeth E Marquetti Iv | Allergy & Immunology | 4 Sweetbriar Dr # 4, Palmetto, GA 30268-9408 | 2012-02-23 |
Please comment or provide details below to improve the information on PROVIDENCE HEALTHCARE.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.