Healthcare Provider Details

I. General information

NPI: 1356382865
Provider Name (Legal Business Name): ATLANTA COLON AND RECTAL SURGERY, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/08/2006
Last Update Date: 09/21/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5667 PEACHTREE DUNWOODY RD NE SUITE 330
ATLANTA GA
30342-1725
US

IV. Provider business mailing address

5667 PEACHTREE DUNWOODY RD NE SUITE 330
ATLANTA GA
30342-1725
US

V. Phone/Fax

Practice location:
  • Phone: 404-252-5669
  • Fax: 404-252-9473
Mailing address:
  • Phone: 404-252-5669
  • Fax: 404-252-9473

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208C00000X
TaxonomyColon & Rectal Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: SANDER ROBERT BINDEROW
Title or Position: CORPORATE SECRETARY
Credential: MD
Phone: 404-252-5669