Provider Demographics
NPI:1912476466
Name:POSITIVE IMPACT HEALTH CENTERS, INC.
Entity type:Organization
Organization Name:POSITIVE IMPACT HEALTH CENTERS, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST IN CHARGE
Authorized Official - Prefix:
Authorized Official - First Name:EMILY
Authorized Official - Middle Name:
Authorized Official - Last Name:BLAIKLOCK
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:404-977-5206
Mailing Address - Street 1:523 CHURCH STREET
Mailing Address - Street 2:SUITE B
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30030
Mailing Address - Country:US
Mailing Address - Phone:404-977-5200
Mailing Address - Fax:404-977-5207
Practice Address - Street 1:523 CHURCH STREET
Practice Address - Street 2:SUITE B
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30030
Practice Address - Country:US
Practice Address - Phone:404-977-5200
Practice Address - Fax:404-977-5207
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:POSITIVE IMPACT HEALTH CENTERS, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-11-14
Last Update Date:2019-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy