Provider Demographics
NPI:1073741971
Name:HIGHLAND URGENT CARE AND FAMILY MEDICINE LLC
Entity Type:Organization
Organization Name:HIGHLAND URGENT CARE AND FAMILY MEDICINE LLC
Other - Org Name:HIGHLAND URGENT CARE AND FAMILY MEDICINE LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSICIAN ASSISTANT
Authorized Official - Prefix:MS
Authorized Official - First Name:AMY
Authorized Official - Middle Name:
Authorized Official - Last Name:HATFIELD
Authorized Official - Suffix:
Authorized Official - Credentials:PA-C
Authorized Official - Phone:404-815-1957
Mailing Address - Street 1:920 PONCE DE LEON AVE NE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30306-4212
Mailing Address - Country:US
Mailing Address - Phone:404-815-1957
Mailing Address - Fax:404-815-1954
Practice Address - Street 1:920 PONCE DE LEON AVE NE
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30306-4212
Practice Address - Country:US
Practice Address - Phone:404-815-1957
Practice Address - Fax:404-815-1954
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-30
Last Update Date:2021-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA005506261QE0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0002XAmbulatory Health Care FacilitiesClinic/CenterEmergency Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA0055069OtherPHYSICIAN ASSISTANT