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General NPI Number Information
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NPI Number | 1194405373
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Entity Type | Organization
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Legal Business Name | PHYSICIAN 360, INC
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Dates
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Enumeration Date | 07/21/2023
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Last Update Date | 01/10/2025
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Provider Practice Location Address
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Address Line | 3379 PEACHTREE RD NE STE 700
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City | ATLANTA
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State | GA
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Zip | 30326-1419
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Country | US
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Telephone | 360-861-6199
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Fax | 360-282-0136
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Provider Business Mailing Address
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Address Line | 3379 PEACHTREE RD NE STE 700
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City | ATLANTA
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State | GA
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Zip | 30326-1419
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Country | US
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Telephone | 360-861-6199
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Fax | 360-282-0136
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Authorized Official
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Title or Position | PRESIDENT AND CHIEF CLINICAL OFFICE
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Name | ELIZABETH WARREN
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Credential | PHARMD
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Telephone | 502-417-7386
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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Taxonomy #3
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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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Taxonomy #4
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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