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NPI Code Detail

MEDICARE: SOUTH ATLANTA URGENT CARE CLINIC LLC

MEDICARE: SOUTH ATLANTA URGENT CARE CLINIC LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1261QU0200XUrgent Care Clinic/Center055916GA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1144548363
Entity Type Code : Organization
Provider Name (Legal Business Name) : SOUTH ATLANTA URGENT CARE CLINIC LLC
Provider Business Mailing Address
First Line : 5185 OLD NATIONAL HWY
Second Line :
City : ATLANTA
State : GA
Zip : 30349-3244
Country : US
Telephone Number : 404-763-9300
Fax Number : 404-763-9306
Provider Business Practice Location Address
First Line : 5185 OLD NATIONAL HWY
Second Line :
City : ATLANTA
State : GA
Zip : 30349-3244
Country : US
Telephone Number : 404-763-9300
Fax Number : 404-763-9304
Authorized Official
Title or Position : OWNER
Name : FELIX AMOA-BONSU
Credential : MD
Telephone Number : 404-903-8830
Provider Enumeration Date : 05/12/2010
Last Update Date : 06/25/2014

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