Healthcare Provider Details

I. General information

NPI: 1578828893
Provider Name (Legal Business Name): ATLANTA MEDICAL ARTS AND WELLNESS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/12/2012
Last Update Date: 07/12/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1800 WATER PL SE STE 100
ATLANTA GA
30339-2041
US

IV. Provider business mailing address

5055 BRER RABBIT RD
STONE MOUNTAIN GA
30083-1858
US

V. Phone/Fax

Practice location:
  • Phone: 770-801-0980
  • Fax: 770-801-9039
Mailing address:
  • Phone: 770-801-0980
  • Fax: 770-801-9039

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2083P0500X
TaxonomyPreventive Medicine/Occupational Environmental Medicine Physician
License Number048274
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number048274
License Number StateGA

VIII. Authorized Official

Name: DR. PATRICE YVETTE MARSHALL
Title or Position: OWNER
Credential: M.D.
Phone: 770-801-0980