| Organization Name: | PASSPORT HEALTH HOLDINGS LLC |
| NPI Number: | 1003261629 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | DOUG SHACKELL (DIRECTOR OF FINANCE) |
| Mailing Address: | 990 Holcomb Bridge Rd Suite 4 Roswell |
| State: | GA US |
| Postal Code: | 300766203 |
| Phone Number: | 8773588648 |
| Fax Number: | 8778776875 |
| NPI Enumeration Date: | 05/02/2016 |
| NPI Last Update Date: | 05/02/2016 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 2083P0901X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | Preventive Medicine |
| Taxonomy Specialization: | Public Health & General Preventive Medicine |
| Taxonomy Definition: | Public health and general preventive medicine focuses on promoting health, preventing disease, and managing the health of communities and defined populations. These practitioners combine population-based public health skills with knowledge of primary, secondary, and tertiary prevention-oriented clinical practice in a wide variety of settings. |