Healthcare Provider Details

I. General information

NPI: 1821203944
Provider Name (Legal Business Name): CLINICA SAGRADO CORAZON DE JESUS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/11/2007
Last Update Date: 09/21/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4163 CLAIRMONT RD SUITE A
CHAMBLEE GA
30341
US

IV. Provider business mailing address

4163 CLAIRMONT ROAD SUITE A
CHAMBLEE GA
30341
US

V. Phone/Fax

Practice location:
  • Phone: 770-458-4408
  • Fax: 800-948-7041
Mailing address:
  • Phone: 770-458-4408
  • Fax: 800-948-7041

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QF0050X
TaxonomyNon-Surgical Family Planning Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number State
# 7
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MARIA A LINARTE
Title or Position: GENERAL MANAGER
Credential:
Phone: 770-458-4408