Provider Demographics
NPI:1598233231
Name:PROVIDER PARTNERS, LLC DBA YOUR VIRTUAL CLINCIAL
Entity Type:Organization
Organization Name:PROVIDER PARTNERS, LLC DBA YOUR VIRTUAL CLINCIAL
Other - Org Name:YOUR VIRTUAL CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RUTHERFORD
Authorized Official - Middle Name:
Authorized Official - Last Name:POLHILL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-401-5200
Mailing Address - Street 1:450 OLD PEACHTREE RD NW STE 101
Mailing Address - Street 2:
Mailing Address - City:SUWANEE
Mailing Address - State:GA
Mailing Address - Zip Code:30024-7289
Mailing Address - Country:US
Mailing Address - Phone:770-401-5200
Mailing Address - Fax:
Practice Address - Street 1:1815 SATELLITE BLVD STE 403
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:GA
Practice Address - Zip Code:30097-5239
Practice Address - Country:US
Practice Address - Phone:770-401-5200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TKRR
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-11-12
Last Update Date:2020-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health