| Origin Healthcare Llc | |
|
1120 Curran St Nw Atlanta GA 30318-5430 | |
| (267) 456-4313 | |
| Not Available |
| Full Name | Origin Healthcare Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 1120 Curran St Nw, Atlanta, Georgia |
| Authorized Official Name and Position | Shivan Amin (PRINCIPAL) |
| Authorized Official Contact | 2674564313 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Origin Healthcare Llc 695 Pylant St Ne Ste 240 Atlanta GA 30306-3728 Ph: (267) 456-4313 | Origin Healthcare Llc 1120 Curran St Nw Atlanta GA 30318-5430 Ph: (267) 456-4313 |
| NPI Number | 1689266314 |
|---|---|
| Provider Enumeration Date | 02/04/2021 |
| Last Update Date | 04/25/2021 |
| Medicare PECOS PAC ID | 8527477249 |
|---|---|
| Medicare Enrollment ID | O20210511000590 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1689266314 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM1300X | Clinic/center - Multi-specialty | (* (Not Available)) | Primary |
| Provider Name | Shivan Harish Amin |
|---|---|
| Provider Type | Practitioner - Otolaryngology |
| Provider Identifiers | NPI Number: 1275857542 PECOS PAC ID: 4486898533 Enrollment ID: I20130911000826 |
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