Healthcare Provider Details

I. General information

NPI: 1538646054
Provider Name (Legal Business Name): ETHNE HEALTH, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/26/2018
Last Update Date: 01/06/2026
Certification Date: 01/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

980 ROWLAND ST STE 4190
CLARKSTON GA
30021-2203
US

IV. Provider business mailing address

980 ROWLAND ST STE 4190
CLARKSTON GA
30021-2203
US

V. Phone/Fax

Practice location:
  • Phone: 470-799-0044
  • Fax: 470-799-0045
Mailing address:
  • Phone: 470-799-0044
  • Fax: 470-799-0045

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number State

VIII. Authorized Official

Name: ROBERT CONTINO
Title or Position: CEO
Credential: MD
Phone: 470-799-0044