Provider Demographics
NPI:1720678246
Name:ADVANCED PRACTICE TELEMEDICINE
Entity Type:Organization
Organization Name:ADVANCED PRACTICE TELEMEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:E
Authorized Official - Last Name:KITCHENS
Authorized Official - Suffix:
Authorized Official - Credentials:NP-C
Authorized Official - Phone:478-443-0964
Mailing Address - Street 1:361 17TH ST NW UNIT 718
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30363-1080
Mailing Address - Country:US
Mailing Address - Phone:478-443-0964
Mailing Address - Fax:
Practice Address - Street 1:361 17TH ST NW UNIT 718
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30363-1080
Practice Address - Country:US
Practice Address - Phone:478-443-0964
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-19
Last Update Date:2021-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-SpecialtyGroup - Single Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty