Healthcare Provider Details

I. General information

NPI: 1194879841
Provider Name (Legal Business Name): MIDTOWN MEDICAL ASSOCIATES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/22/2007
Last Update Date: 11/11/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

550 PEACHTREE ST NE SUITE 1230
ATLANTA GA
30308-2238
US

IV. Provider business mailing address

550 PEACHTREE ST NE SUITE 1230
ATLANTA GA
30308-2238
US

V. Phone/Fax

Practice location:
  • Phone: 404-215-6520
  • Fax: 404-688-8883
Mailing address:
  • Phone: 404-215-6520
  • Fax: 404-688-8883

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: MS. DOT REEVES
Title or Position: PRACTICE MANAGER
Credential:
Phone: 404-215-6525