Provider Demographics
NPI:1295131225
Name:GRASSROOTS HEALTH, LLC
Entity type:Organization
Organization Name:GRASSROOTS HEALTH, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ZACHARY
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:ATEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-249-3552
Mailing Address - Street 1:PO BOX 1205
Mailing Address - Street 2:
Mailing Address - City:POWDER SPRINGS
Mailing Address - State:GA
Mailing Address - Zip Code:30127-7205
Mailing Address - Country:US
Mailing Address - Phone:678-249-3552
Mailing Address - Fax:678-249-3552
Practice Address - Street 1:5000 AUSTELL POWDER SPRINGS RD
Practice Address - Street 2:SUITE 273
Practice Address - City:AUSTELL
Practice Address - State:GA
Practice Address - Zip Code:30106-2427
Practice Address - Country:US
Practice Address - Phone:678-398-6548
Practice Address - Fax:678-398-6550
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COMMUNITY HEALTH CENTER INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-11-19
Last Update Date:2015-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty