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NPI Code Detail

MEDICARE: PHYSICIAN 360, INC

MEDICARE: PHYSICIAN 360, INC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207P00000XEmergency Medicine Physician
2207Q00000XFamily Medicine Physician
3208D00000XGeneral Practice Physician
4207R00000XInternal Medicine Physician

General Provider Information

NPI Number : 1194405373
Entity Type Code : Organization
Provider Name (Legal Business Name) : PHYSICIAN 360, INC
Provider Business Mailing Address
First Line : 3379 PEACHTREE RD NE STE 700
Second Line :
City : ATLANTA
State : GA
Zip : 30326-1419
Country : US
Telephone Number : 360-861-6199
Fax Number : 360-282-0136
Provider Business Practice Location Address
First Line : 3379 PEACHTREE RD NE STE 700
Second Line :
City : ATLANTA
State : GA
Zip : 30326-1419
Country : US
Telephone Number : 360-861-6199
Fax Number : 360-282-0136
Authorized Official
Title or Position : PRESIDENT AND CHIEF CLINICAL OFFICE
Name : ELIZABETH WARREN
Credential : PHARMD
Telephone Number : 502-417-7386
Provider Enumeration Date : 07/21/2023
Last Update Date : 01/10/2025

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Directions to “PHYSICIAN 360, INC ” Practice Location

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