Provider Demographics
NPI:1609829282
Name:PLANNED PARENTHOOD SOUTHEAST, INC
Entity Type:Organization
Organization Name:PLANNED PARENTHOOD SOUTHEAST, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SAMANTHA
Authorized Official - Middle Name:DENISE
Authorized Official - Last Name:GAGANIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-688-9305
Mailing Address - Street 1:241 PEACHTREE ST NE STE 400
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30303-1423
Mailing Address - Country:US
Mailing Address - Phone:404-688-9300
Mailing Address - Fax:404-688-0621
Practice Address - Street 1:440 MORELAND AVE SE
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30316-1926
Practice Address - Country:US
Practice Address - Phone:404-688-9305
Practice Address - Fax:404-688-0621
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-18
Last Update Date:2021-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000052005AMedicaid
SCGA16213OtherSOUTH CAROLINA MEDICAID
SCGA1005OtherSOUTH CAROLINA MEDICAID
=========OtherUNITED HEALTHCARE
=========OtherHUMANA
=========OtherCIGNA
SCGA16213OtherSOUTH CAROLINA MEDICAID
=========OtherAETNA
GA000052005AMedicaid
=========OtherAMERIGROUP COMMUNITY CARE