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General NPI Number Information
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NPI Number | 1023188927
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Entity Type | Organization
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Legal Business Name | ATLANTA SURGERY & TRAUMA, P.C.
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Dates
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Enumeration Date | 11/08/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 285 BOULEVARD NE SUITE 535
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City | ATLANTA
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State | GA
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Zip | 30312-4214
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Country | US
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Telephone | 404-688-1444
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Fax | 404-688-1666
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Provider Business Mailing Address
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Address Line | 285 BOULEVARD NE SUITE 535
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City | ATLANTA
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State | GA
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Zip | 30312-4205
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Country | US
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Telephone | 404-688-1444
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Fax | 404-688-1666
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. VERNON J HENDERSON
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Credential | M.D.
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Telephone | 404-688-1444
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 044746
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License Number State | GA
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