{
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"EIN": null,
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"IsOrgSubpart": "N",
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"OrgName": "ATLAS SURGERY CENTER OF BUCKHEAD, INC",
"LastName": null,
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"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
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"FirstLineMailingAddress": "PO BOX 673363",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "MARIETTA",
"MailingAddressStateName": "GA",
"MailingAddressPostalCode": "30006-0057",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "678-701-2225",
"MailingAddressFaxNumber": "678-412-1672",
"FirstLinePracticeLocationAddress": "2045 PEACHTREE RD NE STE T1",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "ATLANTA",
"PracticeLocationAddressStateName": "GA",
"PracticeLocationAddressPostalCode": "30309-1405",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "786-701-2225",
"PracticeLocationAddressFaxNumber": "678-412-1672",
"EnumerationDate": "03/09/2007",
"LastUpdateDate": "04/01/2021",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "BASILLE",
"AuthorizedOfficialFirstName": "MICHAEL",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "OWNER",
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"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "678-701-2225",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "261QA1903X",
"TaxonomyName": "Ambulatory Surgical Clinic/Center",
"LicenseNumber": "060-096",
"LicenseNumberStateCode": "GA",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}