| Provident Healthcare Llc | |
|
3505 Lassiter Falls Dr Ne Marietta GA 30062-4199 | |
| (414) 916-9031 | |
| Not Available |
| Full Name | Provident Healthcare Llc |
|---|---|
| Speciality | Internal Medicine - Geriatric Medicine |
| Location | 3505 Lassiter Falls Dr Ne, Marietta, Georgia |
| Authorized Official Name and Position | Lakshman K Dinavahi (CHIEF MEDICAL OFFICER) |
| Authorized Official Contact | 6783900120 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Provident Healthcare Llc 3063 Peachtree Industrial Blvd Ste 200 Duluth GA 30097-8639 Ph: (678) 390-0120 | Provident Healthcare Llc 3505 Lassiter Falls Dr Ne Marietta GA 30062-4199 Ph: (414) 916-9031 |
| NPI Number | 1154706075 |
|---|---|
| Provider Enumeration Date | 07/21/2015 |
| Last Update Date | 07/22/2015 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1154706075 | NPI | - | NPPES |
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