Healthcare Provider Details

I. General information

NPI: 1528198678
Provider Name (Legal Business Name): ABSOLUTECARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/07/2007
Last Update Date: 02/01/2021
Certification Date: 02/01/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2140 PEACHTREE ROAD SUITE 232
ATLANTA GA
30309
US

IV. Provider business mailing address

2140 PEACHTREE ROAD SUITE 232
ATLANTA GA
30309
US

V. Phone/Fax

Practice location:
  • Phone: 404-231-4431
  • Fax: 404-231-5677
Mailing address:
  • Phone: 404-231-4431
  • Fax: 404-231-5677

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number044-156
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number060615
License Number StateGA
# 3
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number032036
License Number StateGA
# 5
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: THOMAS J TRENTLY JR.
Title or Position: CFO
Credential:
Phone: 437-380-2814