NPIMap

Organization Active NPI

Activhealthcare, Inc.

  • Preferred Provider Organization
  • Tucker, GA
National Provider Identifier
1013058742
Registry record updated Sep 15, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Preferred Provider OrganizationTaxonomy code 305R00000X
Legal business name
ACTIVHEALTHCARE, INC.
Practice address
1926 Northlake Pkwy Ste 100
Tucker, GA 30084-7069
Phone
(770) 455-0040
Fax
(770) 455-6188
NPI assigned
Feb 8, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 15, 2021

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mr. Mark Brickhouse
Title
Executive Director
Phone
(770) 455-0040

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Preferred Provider Organization 305R00000X Primary

Addresses

Primary practice location

1926 Northlake Pkwy Ste 100
Tucker, GA 30084-7069

Mailing address

1926 Northlake Pkwy Ste 100
Tucker, GA 30084-7069
Phone (770) 455-0040

National Provider Directory

National Provider Directory

Locations

1926 Northlake Pkwy
Ste 100
Tucker, GA 30084
Phone (770) 455-0040

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1170892800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1631664000000",
    "number": "1013058742",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1926 NORTHLAKE PKWY STE 100",
            "city": "TUCKER",
            "state": "GA",
            "postal_code": "300847069",
            "telephone_number": "770-455-0040",
            "fax_number": "770-455-6188"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1926 NORTHLAKE PKWY STE 100",
            "city": "TUCKER",
            "state": "GA",
            "postal_code": "300847069",
            "telephone_number": "770-455-0040",
            "fax_number": "770-455-6188"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ACTIVHEALTHCARE, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-08",
        "last_updated": "2021-09-15",
        "certification_date": "2021-09-15",
        "status": "A",
        "authorized_official_last_name": "BRICKHOUSE",
        "authorized_official_first_name": "MARK",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "770-455-0040",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "305R00000X",
            "taxonomy_group": "",
            "desc": "Preferred Provider Organization",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Tucker, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 15, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.