Healthcare Provider Details

I. General information

NPI: 1922012210
Provider Name (Legal Business Name): AMERICAN PROFESSIONAL ASSOCIATES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/29/2006
Last Update Date: 08/23/2022
Certification Date: 08/23/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3330 PRESTON RIDGE RD STE 300
ALPHARETTA GA
30005-4509
US

IV. Provider business mailing address

PO BOX 745766
ATLANTA GA
30374-5766
US

V. Phone/Fax

Practice location:
  • Phone: 770-350-0126
  • Fax: 770-512-8937
Mailing address:
  • Phone: 770-350-0126
  • Fax: 770-515-9502

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QX0203X
TaxonomyRadiation Oncology Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: CARMEN SIMENS
Title or Position: REVENUE CYCLE MANAGER
Credential:
Phone: 770-255-7440