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General NPI Number Information
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NPI Number | 1033959051
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Entity Type | Organization
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Legal Business Name | ATLANTIS CLINIC PA
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Dates
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Enumeration Date | 05/28/2024
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Last Update Date | 05/28/2024
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Provider Practice Location Address
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Address Line | 1530 4TH ST N
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City | ST PETERSBURG
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State | FL
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Zip | 33704-4412
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Country | US
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Telephone | 727-821-8700
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Fax | 727-821-8770
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Provider Business Mailing Address
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Address Line | 1530 4TH ST N
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City | ST PETERSBURG
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State | FL
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Zip | 33704-4412
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Country | US
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Telephone | 727-821-8700
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Fax | 727-821-8770
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | HOWARD NELSON CHIPMAN
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Credential | MD
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Telephone | 813-476-2321
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number |
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License Number State |
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