Healthcare Provider Details

I. General information

NPI: 1598949976
Provider Name (Legal Business Name): MAURICIO ZAPATA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/21/2007
Last Update Date: 10/05/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 JOHNSON FERRY RD NE
ATLANTA GA
30342-1606
US

IV. Provider business mailing address

3300 BUCKEYE RD SUITE 178
ATLANTA GA
30341-4229
US

V. Phone/Fax

Practice location:
  • Phone: 770-458-6103
  • Fax: 770-234-0437
Mailing address:
  • Phone: 770-458-6103
  • Fax: 770-234-0437

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number055908
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: