Healthcare Provider Details

I. General information

NPI: 1326655846
Provider Name (Legal Business Name): ATLAS INFECTIOUS DISEASE PRACTICE PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/29/2020
Last Update Date: 05/05/2025
Certification Date: 05/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5401 S CONGRESS AVE STE 201
ATLANTIS FL
33462-6637
US

IV. Provider business mailing address

5401 S CONGRESS AVE STE 201
ATLANTIS FL
33462-6637
US

V. Phone/Fax

Practice location:
  • Phone: 561-995-6971
  • Fax: 561-569-8309
Mailing address:
  • Phone: 561-995-6971
  • Fax: 561-569-8309

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number
License Number State

VIII. Authorized Official

Name: JOSEPH HERVE ETIENNE
Title or Position: PRESIDENT, OWNER
Credential: MD
Phone: 561-995-6971