Healthcare Provider Details

I. General information

NPI: 1104150259
Provider Name (Legal Business Name): APPLIED HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/22/2009
Last Update Date: 09/23/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

675 SEMINOLE AVE NE SUITE 103
ATLANTA GA
30307-3408
US

IV. Provider business mailing address

675 SEMINOLE AVE NE SUITE 103
ATLANTA GA
30307-3408
US

V. Phone/Fax

Practice location:
  • Phone: 404-575-4000
  • Fax: 404-575-4010
Mailing address:
  • Phone: 404-575-4000
  • Fax: 404-575-4010

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number State

VIII. Authorized Official

Name: GEORGE ROSERO
Title or Position: PRESIDENT/CEO
Credential:
Phone: 404-575-4000