Provider Demographics
NPI:1194565119
Name:ATLANTIS CLINIC PA
Entity type:Organization
Organization Name:ATLANTIS CLINIC PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:HOWARD
Authorized Official - Middle Name:NELSON
Authorized Official - Last Name:CHIPMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:813-476-2321
Mailing Address - Street 1:1500 N MCMULLEN BOOTH RD STE A1
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33759-2541
Mailing Address - Country:US
Mailing Address - Phone:727-266-1266
Mailing Address - Fax:
Practice Address - Street 1:1500 N MCMULLEN BOOTH RD STE A1
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33759-2541
Practice Address - Country:US
Practice Address - Phone:727-266-1266
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-28
Last Update Date:2024-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty