PROVIDENT HEALTHCARE LLC
Organization (NPI-2)
Active
Internal Medicine, Geriatric Medicine
Provider Information
- NPI Number
1154706075- Provider Type
- Organization / Facility (NPI-2)
- Status
- Active
Contact & Location
- Address
- 3505 LASSITER FALLS DR NE, MARIETTA, GA, 300624199
- Phone
- (414) 916-9031
Specialties & Taxonomies
Internal Medicine
License: GA #07088
Internal Medicine, Hospice and Palliative Medicine
License: GA #07088
Internal Medicine, Geriatric Medicine
Primary License: GA #07088