Healthcare Provider Details

I. General information

NPI: 1851836100
Provider Name (Legal Business Name): ATLANTA PRIMARY CARE HOUSE CALLS FOR SENIOR COMMUNITIES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/22/2016
Last Update Date: 05/19/2021
Certification Date: 05/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3567 BOZEMAN LAKE RD NW
KENNESAW GA
30144-2010
US

IV. Provider business mailing address

3567 BOZEMAN LAKE RD NW
KENNESAW GA
30144-2010
US

V. Phone/Fax

Practice location:
  • Phone: 404-414-3434
  • Fax: 678-426-7190
Mailing address:
  • Phone: 404-414-3434
  • Fax: 678-426-7190

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number19964
License Number StateGA
# 3
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number035277
License Number StateGA
# 4
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number19964
License Number StateGA
# 5
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number19964
License Number StateGA
# 6
Primary TaxonomyN
Taxonomy Code207RH0002X
TaxonomyHospice and Palliative Medicine (Internal Medicine) Physician
License Number19964
License Number StateGA

VIII. Authorized Official

Name: JANICE K HOGUE-KINAHAN
Title or Position: OWNER
Credential: APRN-C
Phone: 404-414-3434