Healthcare Provider Details

I. General information

NPI: 1609829282
Provider Name (Legal Business Name): PLANNED PARENTHOOD SOUTHEAST, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/18/2006
Last Update Date: 01/14/2021
Certification Date: 01/14/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

440 MORELAND AVE SE
ATLANTA GA
30316-1926
US

IV. Provider business mailing address

241 PEACHTREE ST NE STE 400
ATLANTA GA
30303-1423
US

V. Phone/Fax

Practice location:
  • Phone: 404-688-9305
  • Fax: 404-688-0621
Mailing address:
  • Phone: 404-688-9300
  • Fax: 404-688-0621

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MRS. SAMANTHA DENISE GAGANIS
Title or Position: PRACTICE MANAGER
Credential:
Phone: 404-688-9305