Healthcare Provider Details

I. General information

NPI: 1699450098
Provider Name (Legal Business Name): ATLANTAMED UC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/21/2023
Last Update Date: 08/30/2023
Certification Date: 08/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11912 JONES BRIDGE RD
ALPHARETTA GA
30005-4613
US

IV. Provider business mailing address

4113 BARRY PL
CHAMBLEE GA
30341-1203
US

V. Phone/Fax

Practice location:
  • Phone: 678-990-1831
  • Fax: 404-937-6299
Mailing address:
  • Phone: 770-588-3230
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ANTHONY FERRARA
Title or Position: CO OWNER
Credential: MD
Phone: 404-992-6144