Healthcare Provider Details

I. General information

NPI: 1023651312
Provider Name (Legal Business Name): ATLANTIC ADVANCED BRANDED CENTER, LLC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/20/2019
Last Update Date: 03/10/2023
Certification Date: 03/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3925 JOHNS CREEK CT STE C2
SUWANEE GA
30024-6618
US

IV. Provider business mailing address

3651 PEACHTREE PKWY STE E-313
SUWANEE GA
30024-6009
US

V. Phone/Fax

Practice location:
  • Phone: 470-268-6980
  • Fax: 888-815-1765
Mailing address:
  • Phone: 470-268-6980
  • Fax: 888-815-1765

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084A0401X
TaxonomyAddiction Medicine (Psychiatry & Neurology) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2084N0600X
TaxonomyClinical Neurophysiology Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code2084P2900X
TaxonomyPain Medicine (Psychiatry & Neurology) Physician
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code2084S0010X
TaxonomySports Medicine (Psychiatry & Neurology) Physician
License Number
License Number State
# 6
Primary TaxonomyY
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number
License Number State
# 7
Primary TaxonomyN
Taxonomy Code2251N0400X
TaxonomyNeurology Physical Therapist
License Number
License Number State

VIII. Authorized Official

Name: DR. KEWEI YU
Title or Position: PRESIDENT
Credential: MD
Phone: 470-268-6980