Healthcare Provider Details

I. General information

NPI: 1619628591
Provider Name (Legal Business Name): ATG PHARMACY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/12/2022
Last Update Date: 03/07/2023
Certification Date: 01/12/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4774 LOWER ROSWELL RD STE 104
MARIETTA GA
30068-4669
US

IV. Provider business mailing address

4774 LOWER ROSWELL RD STE 104
MARIETTA GA
30068-4669
US

V. Phone/Fax

Practice location:
  • Phone: 404-891-9301
  • Fax: 404-891-9311
Mailing address:
  • Phone: 404-891-9301
  • Fax: 404-891-9311

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: MR. SAMUEL CARTAGENA JR.
Title or Position: MANAGER
Credential:
Phone: 404-891-9301