PASSPORT HEALTH HOLDINGS LLC (NPI# 1689029134) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1689029134 |
| Entity Type | Organization |
| Organization Name | PASSPORT HEALTH HOLDINGS LLC |
| Practice Address |
5415 Sugarloaf Pkwy Suite 1107 Lawrenceville GA 30043-7832 |
| Mailing Address |
8324 E Hartford Dr Suite 200 Scottsdale AZ 85255-7801 |
| Practice Telephone | 8773588648 |
| Practice Fax Number | 8778776875 |
| Mailing Telephone | 8773588648 |
| Mailing Fax Number | 6026065134 |
| Enumeration Date | 2016-05-03 |
| Last Update Date | 2016-05-03 |
| Authorized Official Name | MR. DOUG SHACKELL (DIRECTOR OF FINANCE) |
| Authorized Official Telephone | 4806469024 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 2083P0901X |
Preventive Medicine Specialization: Public Health & General Preventive Medicine |
Allopathic & Osteopathic Physicians |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1376033233 | Passport Health Holdings LLC | Preventive Medicine | 4647 N 32nd Street, Suite 115 1st Floor, Phoenix, AZ 85018-3346 | 2018-05-16 |
| 1275988891 | Passport Health Holdings LLC | Preventive Medicine | 315 W Ponce De Leon Ave Ste 585, Decatur, GA 30030-2400 | 2016-05-02 |
| 1336579226 | Passport Health Holdings LLC | Clinic/Center | 1402 Shepard Dr, Ste 101, Sterling, VA 20164-4425 | 2013-11-14 |
| 1598195489 | Passport Health Holdings LLC | Clinic/Center | 5890 Sawmill Rd, Suite 100, Dublin, OH 43017-1591 | 2013-11-14 |
| 1669802559 | Passport Health Holdings LLC | Preventive Medicine | 260 W Coleman Blvd, Ste B, Mt Pleasant, SC 29464-3666 | 2013-11-14 |
| 1518397405 | Passport Health Holdings LLC | Preventive Medicine | 400 N Center Drive, Suite 108, Norfolk, VA 23502-0002 | 2013-11-14 |
| 1245660133 | Passport Health Holdings LLC | Clinic/Center | 512 Westwood Office Park, Fredricksburg, VA 22401-5112 | 2013-11-14 |
| 1609206564 | Passport Health Holdings LLC | Preventive Medicine | 2318-b Sunset Blvd, West Columbia, SC 29169-4716 | 2013-11-13 |
| 1043640048 | Passport Health Holdings LLC | Preventive Medicine | 3691 Palmetto Point Blvd, Ste 301, Myrtle Beach, SC 29588-1202 | 2013-11-13 |
| 1003245291 | Passport Health Holdings LLC | Preventive Medicine | 6355 Nw 36th St Ste 600, Virginia Gardens, FL 33166-7027 | 2013-11-07 |
| Street Address |
5415 SUGARLOAF PKWY SUITE 1107 |
| City | LAWRENCEVILLE |
| State | GA |
| Zip Code | 30043-7832 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1689085136 | Cvc Inc | Hearing Aid Equipment | 5415 Sugarloaf Pkwy, Suite 1103, Lawrenceville, GA 30043-7832 | 2014-05-17 |
| 1457905135 | Olayinka A. Lewis | Nurse Practitioner | 5415 Sugarloaf Pkwy, Lawrenceville, GA 30043-7832 | 2019-07-30 |
| 1316358757 | Christopher Campellone | Hearing Instrument Specialist | 5415 Sugarloaf Pkwy, Suite 1103, Lawrenceville, GA 30043-7832 | 2014-05-19 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1609483882 | Brittany Javier Dunn | Counselor | 2387 Lawrenceville Huntcrest Way, Lawreneville, GA 30043 | 2020-09-30 |
| 1629614037 | Terrea Gina Bridges | Behavior Technician | 2387 Huntcrest Rd, Lawrenceville, GA 30043 | 2019-11-20 |
| 1215581756 | Elegant Lm Management, LLC | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 1020 Meadowsong Circle, Lawrenceville, GA 30043 | 2019-08-01 |
| 1093299778 | Shareef Nahas | Clinical Medical Laboratory | 1130 Hurricane Shoals Rd, Suite 1800, Lawrenceville, GA 30043 | 2018-09-19 |
| 1649766874 | Nutritionecw LLC | Dietitian, Registered | 1755 North Brown Rd, Ste.200, Lawrenceville, GA 30043 | 2018-07-11 |
| 1962997965 | David Le Nguyen | Dentist | 2000 Riverside Pkwy Ste 200, Lawrenceville, GA 30043 | 2018-06-22 |
| 1932611688 | Asfc Outreach Therapeutic Counseling Services, LLC | Counselor | 1755 North Brown Road, Suite 200, Lawrenceville, GA 30043 | 2017-11-02 |
| 1518486810 | Shira Brey Williams | Specialist/Technologist | 1030 Collins Hill Rd, Lawrenceville, GA 30043 | 2017-09-18 |
| 1700300795 | Nympha J. Mathurin Meadows | Behavioral Analyst | 650 Oxford Crest Ct, Lawrenceville, GA 30043 | 2017-08-01 |
| 1992245591 | Jagruti Chaudhari | Nurse Practitioner | 855 Buford Drive, Lawrenceville, GA 30043 | 2017-03-01 |
| Find all providers in zip 30043 | ||||
| Taxonomy Code | 2083P0901X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Preventive Medicine |
| Specialization | Public Health & General Preventive Medicine |
| Public health and general preventive medicine focuses on promoting health, preventing disease, and managing the health of communities and defined populations. These practitioners combine population-based public health skills with knowledge of primary, secondary, and tertiary prevention-oriented clinical practice in a wide variety of settings. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Preventive Medicine, 2007. http://www.abprevmed.org/. American Osteopathic Board of Preventive Medicine, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Preventive Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Preventive Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1851759096 | On-site Health Solutions of Atlanta, LLC | Preventive Medicine | 1585 Old Norcross Rd, 102, Lawrenceville, GA 30046-4055 | 2016-02-02 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1730715137 | Ernest E Smith | Preventive Medicine | 115 W Dearborn Cir, Decatur, GA 30030-4474 | 2020-03-17 |
| 1033749288 | Atlanta Clinical Research Centers LLC | Preventive Medicine | 5673 Peachtree Dunwoody Rd Ste 440a, Atlanta, GA 30342-1797 | 2020-01-16 |
| 1316433105 | Thomas Boggs Richards | Preventive Medicine | 2067 Amberwood Way Ne, Atlanta, GA 30345-3903 | 2018-07-05 |
| 1871016592 | Sonja Suzzete Hutchins | Preventive Medicine | 435 Joseph E Lowery Blvd Sw, Atlanta, GA 30310-1471 | 2017-07-25 |
| 1922453547 | Passport Health Holdings, LLC | Preventive Medicine | 2470 Windy Hill Rd Se Ste 107, Marietta, GA 30067-8614 | 2016-05-02 |
| 1275988891 | Passport Health Holdings LLC | Preventive Medicine | 315 W Ponce De Leon Ave Ste 585, Decatur, GA 30030-2400 | 2016-05-02 |
| 1619336286 | Antonio Neri | Preventive Medicine | 1600 Clifton Rd Ne # Mse-92, Atlanta, GA 30329-4018 | 2016-02-11 |
| 1134597057 | Zachary Taylor IIi | Preventive Medicine | 1710 Whitehouse Ct, Dalton, GA 30720-8523 | 2015-09-09 |
| 1730557729 | Populations and Interventions Team Company (pitc) | Preventive Medicine | 3182 Berthas Overlook, Douglasville, GA 30135-8458 | 2015-09-08 |
| 1609252626 | Anthony Robbins | Preventive Medicine | 2707 Whispering Pines Ct, Decatur, GA 30033-1453 | 2015-07-31 |
| Find all providers with the same taxonomy | ||||
| City | LAWRENCEVILLE |
| Zip Code | 30043 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.