MEDICARE: METRO MEDICAL & DENTAL SERVICES INC.

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
1	174400000X	Specialist

General Provider Information

NPI Number	:	1316273618
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	METRO MEDICAL & DENTAL SERVICES INC.

Provider Business Mailing Address
First Line	:	6255 BARFIELD RD NE
Second Line	:	SUITE 155
City	:	ATLANTA
State	:	GA
Zip	:	30328-4319
Country	:	US
Telephone Number	:	404-255-1101
Fax Number	:	404-257-1431

Provider Business Practice Location Address
First Line	:	6255 BARFIELD RD NE
Second Line	:	SUITE 155
City	:	ATLANTA
State	:	GA
Zip	:	30328-4319
Country	:	US
Telephone Number	:	404-255-1101
Fax Number	:	404-257-1431

Authorized Official
Title or Position	:	PRACTICE ADMINISTRATOR
Name	:	MRS. CYNTHIA MARIE TATE
Credential	:
Telephone Number	:	404-257-1101

Provider Enumeration Date	:	10/22/2009
Last Update Date	:	04/13/2010

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