Healthcare Provider Details

I. General information

NPI: 1073741971
Provider Name (Legal Business Name): HIGHLAND URGENT CARE AND FAMILY MEDICINE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/30/2009
Last Update Date: 02/01/2021
Certification Date: 02/01/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

920 PONCE DE LEON AVE NE
ATLANTA GA
30306-4212
US

IV. Provider business mailing address

920 PONCE DE LEON AVE NE
ATLANTA GA
30306-4212
US

V. Phone/Fax

Practice location:
  • Phone: 404-815-1957
  • Fax: 404-815-1954
Mailing address:
  • Phone: 404-815-1957
  • Fax: 404-815-1954

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QE0002X
TaxonomyEmergency Care Clinic/Center
License Number005506
License Number StateGA

VIII. Authorized Official

Name: MS. AMY HATFIELD
Title or Position: PHYSICIAN ASSISTANT
Credential: PA-C
Phone: 404-815-1957