Provider Demographics
NPI:1184216715
Name:ATLANTA TELEHEALTH
Entity Type:Organization
Organization Name:ATLANTA TELEHEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:COURTNEY
Authorized Official - Middle Name:
Authorized Official - Last Name:HARRING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-761-5956
Mailing Address - Street 1:3941 OLD ATLANTA STATION DR SE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30339-1984
Mailing Address - Country:US
Mailing Address - Phone:678-761-5956
Mailing Address - Fax:
Practice Address - Street 1:3941 OLD ATLANTA STATION DR SE
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30339-1984
Practice Address - Country:US
Practice Address - Phone:678-761-5956
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-04
Last Update Date:2021-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)