Healthcare Provider Details

I. General information

NPI: 1023601887
Provider Name (Legal Business Name): ATLANTIC VISITING PRACTICE PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/12/2021
Last Update Date: 02/12/2021
Certification Date: 02/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6310 BEACH BLVD
JACKSONVILLE FL
32216-2708
US

IV. Provider business mailing address

6310 BEACH BLVD
JACKSONVILLE FL
32216-2708
US

V. Phone/Fax

Practice location:
  • Phone: 904-551-9757
  • Fax: 904-551-9701
Mailing address:
  • Phone: 904-551-9757
  • Fax: 904-551-9701

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0805X
TaxonomyGeriatric Psychiatry Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. BABUR H BHATTI
Title or Position: P, T
Credential: MD
Phone: 703-609-6430