Provider Demographics
NPI:1457959017
Name:PERISCOPE COMMUNITY HEALTH SERVICES
Entity type:Organization
Organization Name:PERISCOPE COMMUNITY HEALTH SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ECO
Authorized Official - Prefix:MR
Authorized Official - First Name:ARZINE
Authorized Official - Middle Name:
Authorized Official - Last Name:IHEME
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-461-4594
Mailing Address - Street 1:2436 HADLOW LN SE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30339-9020
Mailing Address - Country:US
Mailing Address - Phone:404-461-4594
Mailing Address - Fax:
Practice Address - Street 1:167 BELLE FOREST CIR
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37221-2103
Practice Address - Country:US
Practice Address - Phone:404-641-4594
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-15
Last Update Date:2020-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral Health
No2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent PsychiatryGroup - Multi-Specialty
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health