Provider Demographics
NPI:1538646054
Name:ETHNE HEALTH
Entity Type:Organization
Organization Name:ETHNE HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:FLINT
Authorized Official - Last Name:MEGILL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:470-799-0044
Mailing Address - Street 1:980 ROWLAND ST STE 4190
Mailing Address - Street 2:
Mailing Address - City:CLARKSTON
Mailing Address - State:GA
Mailing Address - Zip Code:30021-2203
Mailing Address - Country:US
Mailing Address - Phone:470-799-0044
Mailing Address - Fax:470-799-0045
Practice Address - Street 1:980 ROWLAND ST STE 4190
Practice Address - Street 2:
Practice Address - City:CLARKSTON
Practice Address - State:GA
Practice Address - Zip Code:30021-2203
Practice Address - Country:US
Practice Address - Phone:470-799-0044
Practice Address - Fax:470-799-0045
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-26
Last Update Date:2023-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
No2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent PsychiatryGroup - Multi-Specialty