Healthcare Provider Details

I. General information

NPI: 1144548363
Provider Name (Legal Business Name): SOUTH ATLANTA URGENT CARE CLINIC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/12/2010
Last Update Date: 06/25/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5185 OLD NATIONAL HWY
ATLANTA GA
30349-3244
US

IV. Provider business mailing address

5185 OLD NATIONAL HWY
ATLANTA GA
30349-3244
US

V. Phone/Fax

Practice location:
  • Phone: 404-763-9300
  • Fax: 404-763-9304
Mailing address:
  • Phone: 404-763-9300
  • Fax: 404-763-9306

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number055916
License Number StateGA

VIII. Authorized Official

Name: FELIX AMOA-BONSU
Title or Position: OWNER
Credential: MD
Phone: 404-903-8830