Provider Demographics
NPI:1619064847
Name:POSITIVE IMPACT HEALTH CENTERS, INC
Entity Type:Organization
Organization Name:POSITIVE IMPACT HEALTH CENTERS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FIINANCE/DATA MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:BRACE
Authorized Official - Middle Name:JASON
Authorized Official - Last Name:ARNETTE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-962-8396
Mailing Address - Street 1:3350 BRECKINRIDGE BLVD STE 200
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:GA
Mailing Address - Zip Code:30096-4959
Mailing Address - Country:US
Mailing Address - Phone:770-962-8396
Mailing Address - Fax:
Practice Address - Street 1:3350 BRECKINRIDGE BLVD STE 200
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:GA
Practice Address - Zip Code:30096
Practice Address - Country:US
Practice Address - Phone:770-962-8396
Practice Address - Fax:770-962-1291
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-09
Last Update Date:2018-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000675342AMedicaid
GAGRP6335Medicare UPIN
GAY16164Medicare UPIN