Provider Demographics
NPI:1659160687
Name:PROACTIVE SCREENING SOLUTIONS LLC
Entity type:Organization
Organization Name:PROACTIVE SCREENING SOLUTIONS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TONETTA
Authorized Official - Middle Name:
Authorized Official - Last Name:WHITE ATLEY
Authorized Official - Suffix:
Authorized Official - Credentials:CCMA,PCT
Authorized Official - Phone:800-590-0114
Mailing Address - Street 1:9905 N DAVIDSON PKWY STE 105C
Mailing Address - Street 2:
Mailing Address - City:STOCKBRIDGE
Mailing Address - State:GA
Mailing Address - Zip Code:30281-4231
Mailing Address - Country:US
Mailing Address - Phone:800-590-0114
Mailing Address - Fax:
Practice Address - Street 1:9905 N DAVIDSON PKWY STE 105C
Practice Address - Street 2:
Practice Address - City:STOCKBRIDGE
Practice Address - State:GA
Practice Address - Zip Code:30281-4231
Practice Address - Country:US
Practice Address - Phone:800-590-0114
Practice Address - Fax:800-590-0114
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-05-05
Last Update Date:2025-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QX0100XAmbulatory Health Care FacilitiesClinic/CenterOccupational Medicine
No261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
No291U00000XLaboratoriesClinical Medical Laboratory