Healthcare Provider Details

I. General information

NPI: 1255128070
Provider Name (Legal Business Name): CAP ATL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/23/2025
Last Update Date: 09/04/2025
Certification Date: 09/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1035 CAMP AVE
ROSWELL GA
30075-3587
US

IV. Provider business mailing address

1035 CAMP AVE
ROSWELL GA
30075-3587
US

V. Phone/Fax

Practice location:
  • Phone: 770-335-1806
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number
License Number State

VIII. Authorized Official

Name: MORGAN BUKO
Title or Position: CEO
Credential: DNP, CRNA
Phone: 770-335-1806