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General NPI Number Information
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NPI Number | 1093074551
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Entity Type | Organization
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Legal Business Name | MTN HEALTHCARE GROUP, LLC
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Dates
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Enumeration Date | 05/03/2012
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Last Update Date | 05/03/2012
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Provider Practice Location Address
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Address Line | 1117 PERIMETER CTR W SUITE N404
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City | ATLANTA
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State | GA
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Zip | 30338-5451
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Country | US
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Telephone | 770-817-4117
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Fax | 770-817-4105
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Provider Business Mailing Address
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Address Line | 1117 PERIMETER CTR W SUITE N404
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City | ATLANTA
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State | GA
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Zip | 30338-5451
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Country | US
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Telephone | 770-817-4117
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Fax | 770-817-4105
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Authorized Official
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Title or Position | DIRECTOR
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Name | MR. CESAR AUGUSTO MAZZOTTA
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Credential |
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Telephone | 770-817-4117
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 2080P0205X
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Taxonomy Name | Pediatric Endocrinology Physician
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 2084P0804X
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Taxonomy Name | Child & Adolescent Psychiatry Physician
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number |
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License Number State |
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