NPIMap

Organization Active NPI

Passport Health Holdings LLC

  • Public Health & General Preventive Medicine Physician
  • Lawrenceville, GA
National Provider Identifier
1689029134
Registry record updated Apr 1, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Public Health & General Preventive Medicine PhysicianTaxonomy code 2083P0901X
Legal business name
PASSPORT HEALTH HOLDINGS LLC
Practice address
5415 Sugarloaf Pkwy
Suite 1107
Lawrenceville, GA 30043-7832
Phone
(877) 358-8648
Fax
(877) 877-6875
NPI assigned
May 3, 2016
Last updated
Apr 1, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 1, 2022

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

Authorized official

Name
Mr. Paul Fishburn
Title
Chief Operating Officer
Phone
(480) 646-9020

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Public Health & General Preventive Medicine Physician 2083P0901X NU Primary

Addresses

Primary practice location

5415 Sugarloaf Pkwy
Suite 1107
Lawrenceville, GA 30043-7832

Mailing address

668 N 44TH St
Suite 100W
Phoenix, AZ 85008-6507
Phone (877) 358-8648

National Provider Directory

National Provider Directory
Tax ID family
Passport Health Holdings LLC219 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 11

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

Locations

5415 Sugarloaf Pkwy
Ste 1107
Lawrenceville, GA 30043

NPI Registry JSON

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

{
    "created_epoch": "1462233600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1648771200000",
    "number": "1689029134",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "668 N 44TH ST",
            "address_2": "SUITE 100W",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850086507",
            "telephone_number": "877-358-8648",
            "fax_number": "877-877-6875"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5415 SUGARLOAF PKWY",
            "address_2": "SUITE 1107",
            "city": "LAWRENCEVILLE",
            "state": "GA",
            "postal_code": "300437832",
            "telephone_number": "877-358-8648",
            "fax_number": "877-877-6875"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PASSPORT HEALTH HOLDINGS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-05-03",
        "last_updated": "2022-04-01",
        "certification_date": "2022-04-01",
        "status": "A",
        "authorized_official_last_name": "FISHBURN",
        "authorized_official_first_name": "PAUL",
        "authorized_official_title_or_position": "CHIEF OPERATING OFFICER",
        "authorized_official_telephone_number": "480-646-9020",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "2083P0901X",
            "taxonomy_group": "",
            "desc": "Preventive Medicine, Public Health & General Preventive Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lawrenceville, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 1, 2022; 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.