Healthcare Provider Details

I. General information

NPI: 1073826590
Provider Name (Legal Business Name): ATLANTA MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/26/2010
Last Update Date: 07/26/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 WINDY RIDGE LN SE
ATLANTA GA
30339-2432
US

IV. Provider business mailing address

401 WINDY RIDGE LN SE
ATLANTA GA
30339-2432
US

V. Phone/Fax

Practice location:
  • Phone: 404-605-2034
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code284300000X
TaxonomySpecial Hospital
License Number4199
License Number StateGA

VIII. Authorized Official

Name: MIRIAM PARKER
Title or Position: PROGRAM DIRECTOR
Credential: MD
Phone: 404-225-4342