Healthcare Provider Details

I. General information

NPI: 1295148732
Provider Name (Legal Business Name): ATLANTA CENTER FOR URINARY CONTROL, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/03/2014
Last Update Date: 06/03/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1555 JANMAR RD
SNELLVILLE GA
30078-5606
US

IV. Provider business mailing address

1555 JANMAR RD
SNELLVILLE GA
30078-5606
US

V. Phone/Fax

Practice location:
  • Phone: 678-344-8900
  • Fax: 678-666-5201
Mailing address:
  • Phone: 678-344-8900
  • Fax: 678-666-5201

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number
License Number State

VIII. Authorized Official

Name: JITESH V PATEL
Title or Position: PRESIDENT
Credential: MD
Phone: 678-344-8900