Basic Information
| Provider Information | |||||||||
| NPI: | 1689953556 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | AHP OF HOLLYWOOD LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1150 N 35TH AVE | ||||||||
| Address2: | SUITE 455 | ||||||||
| City: | HOLLYWOOD | ||||||||
| State: | FL | ||||||||
| PostalCode: | 330215424 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9549617771 | ||||||||
| FaxNumber: | 9549619633 | ||||||||
| Practice Location | |||||||||
| Address1: | 3079 PEACHTREE INDUSTRIAL BLVD | ||||||||
| Address2: | |||||||||
| City: | DULUTH | ||||||||
| State: | GA | ||||||||
| PostalCode: | 300972215 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7709455330 | ||||||||
| FaxNumber: | 6785463606 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/10/2011 | ||||||||
| LastUpdateDate: | 08/10/2011 | ||||||||
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| AuthorizedOfficialLastName: | WACHOWIAK | ||||||||
| AuthorizedOfficialFirstName: | GREGORY | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 7709455330 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367500000X | Y | 193200000X MULTI-SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |
No ID Information.