Provider Demographics
NPI:1679292437
Name:PREFERRED VIRTUAL HEALTHCARE, INC
Entity type:Organization
Organization Name:PREFERRED VIRTUAL HEALTHCARE, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER, CEO
Authorized Official - Prefix:
Authorized Official - First Name:SHENEETA
Authorized Official - Middle Name:MECHELLE
Authorized Official - Last Name:WATTS
Authorized Official - Suffix:
Authorized Official - Credentials:PA
Authorized Official - Phone:678-632-1602
Mailing Address - Street 1:2330 SCENIC HWY S
Mailing Address - Street 2:
Mailing Address - City:SNELLVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30078-3115
Mailing Address - Country:US
Mailing Address - Phone:678-632-1602
Mailing Address - Fax:949-437-3629
Practice Address - Street 1:2330 SCENIC HWY S
Practice Address - Street 2:
Practice Address - City:SNELLVILLE
Practice Address - State:GA
Practice Address - Zip Code:30078-3115
Practice Address - Country:US
Practice Address - Phone:678-632-1602
Practice Address - Fax:949-437-3629
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-24
Last Update Date:2022-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA1659618379Medicaid