Healthcare Provider Details

I. General information

NPI: 1053403857
Provider Name (Legal Business Name): ATLANTA PRIMARY CARE CENTER, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/29/2006
Last Update Date: 10/26/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

285 BOULEVARD NE SUITE 435
ATLANTA GA
30312-4205
US

IV. Provider business mailing address

285 BOULEVARD NE SUITE 435
ATLANTA GA
30312-4205
US

V. Phone/Fax

Practice location:
  • Phone: 404-524-8950
  • Fax: 404-524-8948
Mailing address:
  • Phone: 404-524-8950
  • Fax: 404-524-8948

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. DELPHANIE DESHAN HEAD
Title or Position: CEO
Credential: M.D.
Phone: 404-524-8950