Healthcare Provider Details

I. General information

NPI: 1760290647
Provider Name (Legal Business Name): ATK INCORP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/23/2024
Last Update Date: 12/23/2024
Certification Date: 12/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

220 RIVER DR STE B
CARTERSVILLE GA
30120-4100
US

IV. Provider business mailing address

7 WESTCHESTER DR
CARTERSVILLE GA
30120-6448
US

V. Phone/Fax

Practice location:
  • Phone: 678-215-1533
  • Fax:
Mailing address:
  • Phone: 770-712-6521
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081S0010X
TaxonomySports Medicine (Physical Medicine & Rehabilitation) Physician
License Number
License Number State

VIII. Authorized Official

Name: ASA WILLIAMS
Title or Position: OWNER
Credential:
Phone: 770-712-6521