Healthcare Provider Details

I. General information

NPI: 1992021075
Provider Name (Legal Business Name): ADAM BENJAMIN PRATER MD/MPH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/14/2010
Last Update Date: 04/28/2022
Certification Date: 04/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1364 CLIFTON RD NE DEPARTMENT OF RADIOLOGY BG-20
ATLANTA GA
30322-1059
US

IV. Provider business mailing address

816 W CANNON ST
FORT WORTH TX
76104-3194
US

V. Phone/Fax

Practice location:
  • Phone: 404-712-4519
  • Fax:
Mailing address:
  • Phone: 817-321-0404
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085D0003X
TaxonomyDiagnostic Neuroimaging (Radiology) Physician
License Number75871
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberT2955
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: