Healthcare Provider Details

I. General information

NPI: 1639459407
Provider Name (Legal Business Name): DOWNTOWN ATLANTA MEDICAL CENTER, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/24/2011
Last Update Date: 08/24/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

610 NORTHSIDE DR NW STE. B
ATLANTA GA
30318-6927
US

IV. Provider business mailing address

610 NORTHSIDE DR NW STE. B
ATLANTA GA
30318-6927
US

V. Phone/Fax

Practice location:
  • Phone: 404-419-2050
  • Fax:
Mailing address:
  • Phone: 404-419-2050
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number23771
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License Number23771
License Number StateGA
# 3
Primary TaxonomyN
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License Number23771
License Number StateGA
# 4
Primary TaxonomyN
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number23771
License Number StateGA

VIII. Authorized Official

Name: DR. FREDERICK D. MOSER
Title or Position: PRESIDENT
Credential: M.D.
Phone: 404-419-2050