# PROVIDENCE HEALTHCARE

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1699895961
- **Authorized official:** MRS. MARY LEACH (OFFICE MANAGER)
- **Authorized official phone:** (770) 676-6000

## Contact information

- **Practice address:** 4646 N SHALLOWFORD RD, ATLANTA, GA 30338-6304
- **Practice address phone:** (770) 676-6000
- **Practice address fax:** (770) 392-9805
- **Mailing address:** 4646 N SHALLOWFORD RD, ATLANTA, GA 30338-6304
- **Mailing address phone:** (770) 676-6000
- **Mailing address fax:** (770) 392-9805

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 111N00000X | Chiropractor | CHIR005530 | GA | — |
| 171100000X | Acupuncturist | 000186 | FL | — |
| 207KI0005X | Clinical & Laboratory Immunology (Allergy & Immunology) Physician | — | GA | Yes |

## Other

- **Enumeration date:** 03/30/2007
- **Last updated:** 07/21/2022