Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Provident Healthcare LLC

Organization Internal Medicine Physician · NPI 1154706075

Provident Healthcare LLC is an Internal Medicine Physician in Marietta, Georgia. Licensed in Georgia. Registered with an NPI since 2015.

Licensed in
GA
In the registry since
2015
Specialties on file
3
What do these letters mean?
LLC — Limited liability company
A form of business registration, not a clinical qualification.

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Practice location Address checks out

3505 Lassiter Falls Dr NE
Marietta, GA 30062-4199
Phone: (414) 916-9031
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Geriatric Medicine (Internal Medicine) Physician (primary) Taxonomy 207RG0300X · Licence 07088 (GA)
Internal Medicine Physician Taxonomy 207R00000X · Licence 07088 (GA)
Hospice and Palliative Medicine (Internal Medicine) Physician Taxonomy 207RH0002X · Licence 07088 (GA)

Record details

NPI number1154706075
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Lakshman Dinavahi — Chief Medical Officer · (678) 390-0120
NPI enumeratedJuly 21, 2015
Last updated in NPPESJuly 22, 2015
Mailing address3063 Peachtree Industrial Blvd, Ste 200, Duluth, GA 30097-8639

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