Healthcare Provider Details

I. General information

NPI: 1750656906
Provider Name (Legal Business Name): AIDS HEALTHCARE FOUNDATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/20/2012
Last Update Date: 09/11/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5700 HILLANDALE DR SUITE 100
LITHONIA GA
30058-4103
US

IV. Provider business mailing address

6255 W SUNSET BLVD FL 21
LOS ANGELES CA
90028-7422
US

V. Phone/Fax

Practice location:
  • Phone: 323-436-5019
  • Fax: 323-337-9142
Mailing address:
  • Phone: 323-860-5200
  • Fax: 833-241-7615

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: DONNA STIDHAM
Title or Position: CHIEF, MANAGED CARE
Credential:
Phone: 323-436-5025