Healthcare Provider Details

I. General information

NPI: 1689063554
Provider Name (Legal Business Name): ATL COLORECTAL SURGERY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/15/2015
Last Update Date: 01/15/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

95 COLLIER RD NW SUITE 4025
ATLANTA GA
30309-1796
US

IV. Provider business mailing address

95 COLLIER RD NW SUITE 4025
ATLANTA GA
30309
US

V. Phone/Fax

Practice location:
  • Phone: 404-574-5820
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MONICA HUM
Title or Position: PHYSICAN/ MANAGING PARTNER
Credential: M.D.
Phone: 404-574-5820