Provider Demographics
NPI:1467043877
Name:PANOHEALTH LLC
Entity Type:Organization
Organization Name:PANOHEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR HEALTH MANAGEMENT DIVISION
Authorized Official - Prefix:DR
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:
Authorized Official - Last Name:WHITTAKER
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:404-721-2012
Mailing Address - Street 1:3607 PARKWAY LN STE 300
Mailing Address - Street 2:
Mailing Address - City:PEACHTREE CORNERS
Mailing Address - State:GA
Mailing Address - Zip Code:30092-2802
Mailing Address - Country:US
Mailing Address - Phone:404-712-2012
Mailing Address - Fax:
Practice Address - Street 1:3607 PARKWAY LN STE 300
Practice Address - Street 2:
Practice Address - City:PEACHTREE CORNERS
Practice Address - State:GA
Practice Address - Zip Code:30092-2802
Practice Address - Country:US
Practice Address - Phone:404-712-2012
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-28
Last Update Date:2021-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center