Healthcare Provider Details

I. General information

NPI: 1508061086
Provider Name (Legal Business Name): ATLANTA UROCARE PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/15/2007
Last Update Date: 05/05/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

777 CLEVELAND AVE SW SUITE 604
ATLANTA GA
30315-7129
US

IV. Provider business mailing address

777 CLEVELAND AVE SW SUITE 604
ATLANTA GA
30315-7129
US

V. Phone/Fax

Practice location:
  • Phone: 404-768-6611
  • Fax: 305-675-2788
Mailing address:
  • Phone: 404-768-6611
  • Fax: 305-675-2788

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number
License Number StateGA

VIII. Authorized Official

Name: ANTHONY BARNES
Title or Position: OWNER
Credential: MD
Phone: 404-768-6611