Healthcare Provider Details

I. General information

NPI: 1720318298
Provider Name (Legal Business Name): ATI HOLDINGS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/06/2010
Last Update Date: 01/06/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1812 MARSH RD STE 505
WILMINGTON DE
19810-4581
US

IV. Provider business mailing address

1208 KIRKWOOD HIGHWAY STE 1
WILMINGTON DE
19805-1844
US

V. Phone/Fax

Practice location:
  • Phone: 302-793-0432
  • Fax: 302-793-0400
Mailing address:
  • Phone: 302-993-1450
  • Fax: 302-993-1454

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name: MR. KRISTIN ACHUFF
Title or Position: CREDENTIALING SPECIALIST
Credential:
Phone: 302-793-0432