Provider Demographics
NPI:1780373290
Name:BLOSSOM Q HEALTH, INC.
Entity type:Organization
Organization Name:BLOSSOM Q HEALTH, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:AVANTIKA
Authorized Official - Middle Name:
Authorized Official - Last Name:VARMA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:404-595-1697
Mailing Address - Street 1:650 PONCE DE LEON AVE NE STE 300
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30308-1864
Mailing Address - Country:US
Mailing Address - Phone:404-595-1697
Mailing Address - Fax:
Practice Address - Street 1:2133 BOYCE CIR
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30066-4514
Practice Address - Country:US
Practice Address - Phone:404-595-1697
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-02
Last Update Date:2023-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty