Healthcare Provider Details

I. General information

NPI: 1285458919
Provider Name (Legal Business Name): LAMAR DESHAWN ATKINS RCP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/11/2024
Last Update Date: 12/12/2024
Certification Date: 12/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4323 N 12TH ST STE 201
PHOENIX AZ
85014-4527
US

IV. Provider business mailing address

4323 N 12TH ST STE 201
PHOENIX AZ
85014-4527
US

V. Phone/Fax

Practice location:
  • Phone: 602-857-2113
  • Fax: 602-364-3809
Mailing address:
  • Phone: 602-857-2113
  • Fax: 602-364-3809

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2278E1000X
TaxonomyEducational Certified Respiratory Therapist
License Number010507
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code2278G0305X
TaxonomyGeriatric Care Certified Respiratory Therapist
License Number010507
License Number StateAZ
# 3
Primary TaxonomyN
Taxonomy Code2278H0200X
TaxonomyHome Health Certified Respiratory Therapist
License Number010507
License Number StateAZ
# 4
Primary TaxonomyN
Taxonomy Code2278S1500X
TaxonomySNF/Subacute Care Certified Respiratory Therapist
License Number010507
License Number StateAZ
# 5
Primary TaxonomyN
Taxonomy Code2278P1004X
TaxonomyPulmonary Diagnostics Certified Respiratory Therapist
License Number010507
License Number StateAZ
# 6
Primary TaxonomyN
Taxonomy Code2278P3900X
TaxonomyNeonatal/Pediatric Certified Respiratory Therapist
License Number010507
License Number StateAZ
# 7
Primary TaxonomyY
Taxonomy Code2278G1100X
TaxonomyGeneral Care Certified Respiratory Therapist
License Number010507
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: