Healthcare Provider Details

I. General information

NPI: 1063110328
Provider Name (Legal Business Name): ATLANTA HEALTH CENTER PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/16/2023
Last Update Date: 06/30/2025
Certification Date: 06/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4905 LAVISTA RD STE B
TUCKER GA
30084-4409
US

IV. Provider business mailing address

4905 LAVISTA RD STE B
TUCKER GA
30084-4409
US

V. Phone/Fax

Practice location:
  • Phone: 770-680-5740
  • Fax: 888-418-8738
Mailing address:
  • Phone: 770-680-5740
  • Fax: 888-418-8738

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP3300X
TaxonomyPain Clinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: DR. OHAD KOTT
Title or Position: OWNER
Credential: GENERAL PRACTIONER
Phone: 770-680-5740