Healthcare Provider Details

I. General information

NPI: 1891518064
Provider Name (Legal Business Name): ATLAS HEALTH, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/05/2024
Last Update Date: 11/05/2024
Certification Date: 11/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1101 K ST NW FL 10
WASHINGTON DC
20005-4210
US

IV. Provider business mailing address

1501 S CLINTON ST
BALTIMORE MD
21224-5730
US

V. Phone/Fax

Practice location:
  • Phone: 866-233-6925
  • Fax:
Mailing address:
  • Phone: 866-233-6925
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MARY JANE FAVAZZA
Title or Position: CEO
Credential:
Phone: 410-528-7109