Healthcare Provider Details

I. General information

NPI: 1063653681
Provider Name (Legal Business Name): AHI ATLANTA, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/11/2009
Last Update Date: 03/11/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5671 PEACHTREE DUNWOODY RD NE SUITE 600
ATLANTA GA
30342-5000
US

IV. Provider business mailing address

550 PEACHTREE ST NE SUITE 1600
ATLANTA GA
30308-2208
US

V. Phone/Fax

Practice location:
  • Phone: 404-257-9000
  • Fax: 404-847-9792
Mailing address:
  • Phone: 404-888-7575
  • Fax: 404-885-7777

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number State

VIII. Authorized Official

Name: JANA C BAKER
Title or Position: ADMINISTRATOR
Credential:
Phone: 404-888-7575