Healthcare Provider Details

I. General information

NPI: 1720784234
Provider Name (Legal Business Name): CLINICA MATERNIDAD DE ATLANTA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/06/2023
Last Update Date: 02/06/2023
Certification Date: 02/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3652 CHAMBLEE DUNWOODY RD STE 2
CHAMBLEE GA
30341-2120
US

IV. Provider business mailing address

3652 CHAMBLEE DUNWOODY RD STE 2
CHAMBLEE GA
30341-2120
US

V. Phone/Fax

Practice location:
  • Phone: 404-809-2006
  • Fax: 404-737-8236
Mailing address:
  • Phone: 404-809-2006
  • Fax: 404-737-8236

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: SANTIAGO A TORRES
Title or Position: OWNER
Credential:
Phone: 404-809-2006