Healthcare Provider Details

I. General information

NPI: 1144369232
Provider Name (Legal Business Name): UNITED HEALTHCARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/05/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3720 DAVINCI CT
NORCROSS GA
30092-7627
US

IV. Provider business mailing address

207 CRESTMONT WAY
CANTON GA
30114-8875
US

V. Phone/Fax

Practice location:
  • Phone: 770-582-4484
  • Fax:
Mailing address:
  • Phone: 678-493-7374
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code302R00000X
TaxonomyHealth Maintenance Organization
License NumberRN174554 NP
License Number StateGA

VIII. Authorized Official

Name: MRS. JILL J PAGANO
Title or Position: HEALTH SERVICES DIRECTOR
Credential: NP
Phone: 770-582-3985