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PROVIDENCE HEALTHCARE
NPI 1699895961
Allergy & Immunology - Clinical & Laboratory Immunology in Atlanta, GA

Active since March 30, 2007
4646 N SHALLOWFORD RD, ATLANTA, GA 30338(770) 676-6000(770) 392-9805 Get Directions Write a Review

NPPES record last updated: July 21, 2022. Verified against the NPPES registry weekly; last sync: August 02, 2026.

About Providence Healthcare NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

PROVIDENCE HEALTHCARE (NPI 1699895961) is a healthcare organization registered as a clinical & laboratory immunology in Atlanta, Georgia and active in the NPI registry since March 2007. The organization lists Mary Leach, Office Manager, as its authorized official.

NPPES Registry Identity

NPI1699895961
Entity TypeOrganization
Primary Taxonomy207KI0005X
Legal Business NamePROVIDENCE HEALTHCARE
Location Address4646 N SHALLOWFORD RDAtlanta, GA 30338-6304
Mailing Address4646 N Shallowford RdAtlanta, GA 30338-6304 · (770) 676-6000 · Fax (770) 392-9805
Phone(770) 676-6000
Fax(770) 392-9805
Organization SubpartNo
Authorized OfficialMary LeachOffice Manager · (770) 676-6000
Enumeration DateMarch 30, 2007
Last NPPES UpdateJuly 21, 2022
✔ NPI 1699895961 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 3

★ Primary SpecialtyAllergy & Immunology · Clinical & Laboratory ImmunologyAllopathic & Osteopathic Physicians
Taxonomy Code207KI0005X
Definition
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.
Also ListedChiropractorTaxonomy 111N00000X · License CHIR005530 (GA)
Also ListedAcupuncturistTaxonomy 171100000X · License 000186 (FL)
4646 N SHALLOWFORD RD, Atlanta, GA 30338
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Other Identifiers 3

Other50014615GA · Tat
Other826713GA · Bluecross Blue Shield
OtherD44849GA · Upin

Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X MULTIPLE SINGLE SPECIALTY GROUP

Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

PROGRESSIVE MEDICAL CENTERS OF AMERICA LTD
Integrative Medicine
4646 N SHALLOWFORD RD
ATLANTA, GA 30338
Dekalb County (770) 676-6000
CARI CATER LAC
Acupuncturist
4646 N SHALLOWFORD RD
ATLANTA, GA 30338
Dekalb County (941) 228-2833
MELISSA NOHR
Health and Wellness Coach
4646 N SHALLOWFORD RD
ATLANTA, GA 30338
Dekalb County (770) 676-6000
MRS. PATTI MATALONE
Registered Nurse
4646 N SHALLOWFORD RD
ATLANTA, GA 30338
Dekalb County (770) 676-6000
AMY TARQUINI ND
Naturopath
4646 N SHALLOWFORD RD
ATLANTA, GA 30338
Dekalb County (770) 676-6000
MRS. CHERYL BURDETTE ND
Naturopath
4646 N SHALLOWFORD RD
DUNWOODY, GA 30338
Dekalb County (678) 736-6374
PROGRESSIVE HEALTHCARE & DIAGNOSTICS, LLC
General Practice
4646 N SHALLOWFORD RD
ATLANTA, GA 30338
Dekalb County (678) 736-6343
NICOLE KROKO STROVINSKAS DIETITIAN
Dietitian, Registered
4646 N SHALLOWFORD RD
ATLANTA, GA 30338
Dekalb County (770) 676-6000

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Providence Healthcare's NPI number?

The NPI number for Providence Healthcare is 1699895961. It was assigned to this organization in the NPPES registry on March 30, 2007.

Where is Providence Healthcare located?

Providence Healthcare is located at 4646 N Shallowford Rd, Atlanta, GA 30338. The listed phone number is (770) 676-6000.

What is Providence Healthcare's specialty?

The primary specialty registered for this NPI is Allergy & Immunology, specializing in Clinical & Laboratory Immunology, with taxonomy code 207KI0005X.

When was this NPI record last updated?

The NPPES record for Providence Healthcare was last updated on July 21, 2022. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 4 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.