Provider Demographics
NPI:1528198678
Name:ABSOLUTECARE, LLC
Entity Type:Organization
Organization Name:ABSOLUTECARE, LLC
Other - Org Name:ABSOLUTECARE, INC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:J
Authorized Official - Last Name:TRENTLY
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:437-380-2814
Mailing Address - Street 1:2140 PEACHTREE ROAD
Mailing Address - Street 2:SUITE 232
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30309
Mailing Address - Country:US
Mailing Address - Phone:404-231-4431
Mailing Address - Fax:404-231-5677
Practice Address - Street 1:2140 PEACHTREE ROAD
Practice Address - Street 2:SUITE 232
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30309
Practice Address - Country:US
Practice Address - Phone:404-231-4431
Practice Address - Fax:404-231-5677
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-07
Last Update Date:2021-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA060615207Q00000X
207Q00000X, 207RI0200X
GA032036207RI0200X
GA044-156291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious DiseaseGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No291U00000XLaboratoriesClinical Medical LaboratoryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA11D0978763OtherCLIA
GA085002644GMedicaid
GA300015856AMedicaid
GA085002644GMedicaid