Healthcare Provider Details

I. General information

NPI: 1043174634
Provider Name (Legal Business Name): ATALLAH HEALTH CARE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/10/2025
Last Update Date: 12/10/2025
Certification Date: 12/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6792 TRIBBLE ST STE 23
LITHONIA GA
30058-4684
US

IV. Provider business mailing address

6792 TRIBBLE ST STE 23
LITHONIA GA
30058-4684
US

V. Phone/Fax

Practice location:
  • Phone: 404-446-3639
  • Fax:
Mailing address:
  • Phone: 404-446-3639
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133N00000X
TaxonomyNutritionist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number
License Number State

VIII. Authorized Official

Name: MS. TACQUORA LASHAE MIXON
Title or Position: CEO
Credential: CNA,CMA
Phone: 404-692-8860