Healthcare Provider Details

I. General information

NPI: 1982954996
Provider Name (Legal Business Name): ATLANTIS MEDICAL SPECIALIST AZ, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/17/2012
Last Update Date: 09/17/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11124 W CALIFORNIA AVE STE G
YOUNGTOWN AZ
85363-1246
US

IV. Provider business mailing address

11124 W CALIFORNIA AVE STE G
YOUNGTOWN AZ
85363-1246
US

V. Phone/Fax

Practice location:
  • Phone: 623-583-2073
  • Fax: 623-583-1099
Mailing address:
  • Phone: 623-583-2073
  • Fax: 623-583-1099

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State
# 7
Primary TaxonomyN
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License Number
License Number State
# 8
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number41375
License Number StateAZ

VIII. Authorized Official

Name: DR. DAVID K TOWNS
Title or Position: OWNER
Credential: MD
Phone: 623-583-2073