OrganizationActive
Providence Healthcare
NPI 1699895961 · Clinical & Laboratory Immunology (Allergy & Immunology) Physician · Atlanta, GA
Provider details
- NPI number
- 1699895961
- Entity type
- Organization
- Primary specialty
- Clinical & Laboratory Immunology (Allergy & Immunology) PhysicianAllopathic & Osteopathic Physicians
- Organization subpart
- No
- Authorized official
- Mary Leach, Office Manager(770) 676-6000
- License
- CHIR005530 (GA)
Specialties & taxonomies
Allopathic & Osteopathic Physicians
Chiropractic Providers
Other Service Providers
Practice location
4646 N Shallowford Rd
Atlanta, GA 30338-6304
Phone: (770) 676-6000
Fax: (770) 392-9805
Approximate (ZIP-level) locationGet directions
Mailing address
4646 N Shallowford Rd
Atlanta, GA 30338-6304
Registry dates
- Enumerated
- 2007-03-30
- Last updated
- 2022-07-21
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.