Providence Healthcare is a
Allergy & Immunology - Clinical & Laboratory Immunology based in Atlanta, Georgia. Providence Healthcare is licensed to practice in Georgia (license number ) and their current practice location is
4646 N Shallowford Rd, Atlanta, Georgia. It can be reached at their office (for appointments etc.) via phone at
(770) 676-6000.
NPI number for Providence Healthcare is 1699895961 and their current mailing address is 4646 N Shallowford Rd, Atlanta, Georgia. Providence Healthcare
does not participate in medicare program and thus does not accept medicare assignments. The facility's NPI Number is 1699895961.
Healthcare Provider's Profile
| Full Name | Providence Healthcare |
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| Type | Facility |
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| Speciality | Allergy & Immunology - Clinical & Laboratory Immunology |
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| Location | 4646 N Shallowford Rd, Atlanta, Georgia |
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| Accepts Medicare Assignments | Does not participate in Medicare Program. The facility may not accept medicare assignment. |
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NPI Data:
- NPI Number: 1699895961
- Provider Enumeration Date: 03/30/2007
- Last Update Date: 07/21/2022
Medical Identifiers
Medical identifiers for Providence Healthcare such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
|---|
| 1699895961 | NPI | - | NPPES |
| 50014615 | Other | GA | TAT |
| 826713 | Other | GA | BLUECROSS BLUE SHIELD |
| D44849 | Other | GA | UPIN |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
|---|
| 111N00000X | Chiropractor | CHIR005530 (Georgia) | Secondary |
| 171100000X | Acupuncturist | 000186 (Florida) | Secondary |
| 207KI0005X | Allergy & Immunology - Clinical & Laboratory Immunology | (Georgia) | Primary |
Medicare Part D Prescriber Enrollment
Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Providence Healthcare is
NOT enrolled with medicare and thus cannot prescribe medicare part D drugs to patients with medicare part D benefits.
Mailing Address and Practice Location
| Mailing Address | Practice Location Address |
|---|
Providence Healthcare
4646 N Shallowford Rd,
Atlanta, GA 30338-6304
Ph: (770) 676-6000 | Providence Healthcare
4646 N Shallowford Rd,
Atlanta, GA 30338-6304
Ph: (770) 676-6000 |
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