MEDICARE: PLANNED PARENTHOOD SOUTHEAST, 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
1	363L00000X	Nurse Practitioner

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1609829282
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PLANNED PARENTHOOD SOUTHEAST, INC

Provider Business Mailing Address
First Line	:	241 PEACHTREE ST NE STE 400
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30303-1423
Country	:	US
Telephone Number	:	404-688-9300
Fax Number	:	404-688-0621

Provider Business Practice Location Address
First Line	:	440 MORELAND AVE SE
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30316-1926
Country	:	US
Telephone Number	:	404-688-9305
Fax Number	:	404-688-0621

Authorized Official
Title or Position	:	PRACTICE MANAGER
Name	:	MRS. SAMANTHA DENISE GAGANIS
Credential	:
Telephone Number	:	404-688-9305

Provider Enumeration Date	:	05/18/2006
Last Update Date	:	01/14/2021

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Directions to “PLANNED PARENTHOOD SOUTHEAST, INC ” Practice Location

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