Provident Healthcare LLC
NPI 1154706075 · Geriatric Medicine (Internal Medicine) Physician · Marietta, GA
Provident Healthcare LLC is a Geriatric Medicine (Internal Medicine) Physician organization in Marietta, GA (NPI 1154706075).
Provider details
- NPI number
- 1154706075
- Entity type
- Organization
- Primary specialty
- Geriatric Medicine (Internal Medicine) PhysicianAllopathic & Osteopathic Physicians
- Organization subpart
- No
- Authorized official
- Lakshman Dinavahi, Chief Medical Officer(678) 390-0120
- License
- 07088 (GA)
Specialties & taxonomies
Allopathic & Osteopathic Physicians
Allopathic & Osteopathic Physicians
Allopathic & Osteopathic Physicians
Profile Score
A profile completeness & documented-activity index — NOT a quality, outcomes, or patient-satisfaction rating.
- Registry tenure38% of score
10 yrs in NPPES registry
- Profile completeness38% of score
100% of core fields populated
- Practice footprint23% of score
1 documented practice location
Signals a provider has no public data for (e.g. Medicare claims) are left out of the score entirely — never counted as zero — so providers without that data are not penalized. See the full formula and weights in our methodology.
Practice location
Mailing address
Registry dates
- Enumerated
- 2015-07-21
- Last updated
- 2015-07-22
Frequently asked questions
- What is Provident Healthcare LLC's NPI number?
- Provident Healthcare LLC's National Provider Identifier (NPI) is 1154706075, a unique 10-digit ID issued by CMS for use in standard healthcare transactions.
- What type of organization is Provident Healthcare LLC?
- Provident Healthcare LLC is classified in the NPPES registry as Geriatric Medicine (Internal Medicine) Physician (Allopathic & Osteopathic Physicians).
- Where is Provident Healthcare LLC located?
- Provident Healthcare LLC's practice location on file with NPPES is 3505 Lassiter Falls Dr Ne, Marietta, GA 30062-4199.
- What is Provident Healthcare LLC's phone number?
- The practice phone number listed in the NPPES registry for Provident Healthcare LLC is (414) 916-9031.
- Who is the authorized official for Provident Healthcare LLC?
- The authorized official listed on Provident Healthcare LLC's NPPES record is Lakshman Dinavahi, Chief Medical Officer. The authorized official registers and maintains the organization's NPI and is not necessarily its owner.
- Is Provident Healthcare LLC's NPI active?
- Yes — Provident Healthcare LLC's NPI (1154706075) is active in the NPPES registry as of the last update on 2015-07-22.
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.