Healthcare Provider Details

I. General information

NPI: 1689953556
Provider Name (Legal Business Name): AHP OF HOLLYWOOD LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/10/2011
Last Update Date: 08/10/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3079 PEACHTREE INDUSTRIAL BLVD
DULUTH GA
30097-2215
US

IV. Provider business mailing address

1150 N 35TH AVE SUITE 455
HOLLYWOOD FL
33021-5424
US

V. Phone/Fax

Practice location:
  • Phone: 770-945-5330
  • Fax: 678-546-3606
Mailing address:
  • Phone: 954-961-7771
  • Fax: 954-961-9633

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number
License Number State

VIII. Authorized Official

Name: GREGORY WACHOWIAK
Title or Position: PRESIDENT
Credential:
Phone: 770-945-5330