Healthcare Provider Details

I. General information

NPI: 1669750071
Provider Name (Legal Business Name): ATLANTA MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/02/2011
Last Update Date: 08/02/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

303 PARKWAY DR NE ATL MED CNTR-GME DEPT. I.M.
ATLANTA GA
30312-1212
US

IV. Provider business mailing address

180 JACKSON ST NE APT 6205
ATLANTA GA
30312-7940
US

V. Phone/Fax

Practice location:
  • Phone: 404-265-4919
  • Fax:
Mailing address:
  • Phone: 571-332-7440
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number4767
License Number StateGA

VIII. Authorized Official

Name: MRS. SHEILA M LAWSHEA
Title or Position: RESIDENCY COORDINATOR
Credential:
Phone: 404-265-4919