Organization
PASSPORT HEALTH HOLDINGS, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. PAUL FISHBURN (COO)
(480) 646-9020
Entity
Organization
Contact information
Practice address
576 COLONIAL PARK DR, SUITE 100, ROSWELL, GA 30075
(844) 358-8648
(877) 877-6875
Mailing address
4343 EAST OUTLIER BLV., SUITE 100W, PHOENIX, AZ 85008-6507
(844) 358-8648
(877) 877-6875
Taxonomy
Speciality
Code
Description
License number
State
172V00000X
Community Health Worker
Primary
—
—
2083P0901X
Public Health & General Preventive Medicine Physician
—
—
Other
Enumeration date
05/02/2016
Last updated
02/20/2023
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