PROVIDENCE HEALTHCARE
Osteopathic Medicine at Shallowford Rd, Atlanta, GA

License number
Georgia CHIR005530
Category
Chiropractic
Type
Chiropractor
License number
Georgia 000186
Category
Acupuncture
Type
Acupuncturist
License number
Georgia =========
Category
Osteopathic Medicine
Type
Clinical & Laboratory Immunology
Owner
Name: MRS. MARY LEACH
Title: OFFICE MANAGER
Phone: (770) 676-6000
Address
Address
4646 N Shallowford Rd, Atlanta, GA 30338
National Provider ID: 1699895961
LicenseFiles verified this license of Nov 7, 2017 at the National Plan and Provider Enumeration System.

Organization information

See more information about PROVIDENCE HEALTHCARE at bizstanding.com

Providence Healthcare Assoc P

4646 N Shallowford Rd, Atlanta, GA 30338

Industry:
Health/Allied Services
Chief Executive Officer:
Frank P. Mattalone Chief Executive Officer, inactive

PROVIDENCE HEALTHCARE ASSOCIATES, PC

4646 N Shallowford Rd, Atlanta, GA 30338

Status:
Inactive
Registration:
Aug 12, 2004
Inactive since:
Aug 27, 2011
State ID:
0448413
Business type:
Domestic Professional Corporation
CFOs:
Frank Mattalone,, P (CEO), 4646 N Shallowford Rd, Atlanta, GA 30338 (Physical),Gez N.d., Agolli (Secretary), 4646 N Shallowford Rd, Atlanta, GA 30338 (Physical),Michael Gramazio,N.d (CFO), 4646 N Shallowford Rd, Atlanta, GA 30338 (Physical)
Agent:
Albert N. Remler, Pc,4200 Northside Pkwy.bd. #200, Atlanta, GA 30327 (Physical)

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