Healthcare Provider Details

I. General information

NPI: 1598781635
Provider Name (Legal Business Name): ATLANTA MEDICAL CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/14/2006
Last Update Date: 03/24/2022
Certification Date: 03/24/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1170 CLEVELAND AVE
EAST POINT GA
30344-3615
US

IV. Provider business mailing address

PO BOX 741252
ATLANTA GA
30374-1252
US

V. Phone/Fax

Practice location:
  • Phone: 404-466-1170
  • Fax:
Mailing address:
  • Phone: 678-242-2002
  • Fax: 678-242-2202

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number060-598
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code341600000X
TaxonomyAmbulance
License Number
License Number State

VIII. Authorized Official

Name: MR. WILLIAM T. MOORE
Title or Position: CEO
Credential:
Phone: 404-256-4000