Healthcare Provider Details

I. General information

NPI: 1982818951
Provider Name (Legal Business Name): METRO ATLANTA ACCESS CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/09/2007
Last Update Date: 09/20/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3885 PRINCETON LAKES WAY SW SUITE 314
ATLANTA GA
30331-5589
US

IV. Provider business mailing address

3885 PRINCETON LAKES WAY SW SUITE 314
ATLANTA GA
30331-5589
US

V. Phone/Fax

Practice location:
  • Phone: 404-349-7770
  • Fax: 404-349-7778
Mailing address:
  • Phone: 404-349-7770
  • Fax: 404-349-7778

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number
License Number State

VIII. Authorized Official

Name: ANGUS C HOWARD JR.
Title or Position: PRESIDENT - CHAIRMAN OF THE BOARD
Credential: MD
Phone: 404-696-7300