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General NPI Number Information
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NPI Number | 1255639613
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Entity Type | Organization
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Legal Business Name | ATLANTIS MEDICAL CLINIC - AUSTIN, P.A.
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Dates
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Enumeration Date | 03/09/2011
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Last Update Date | 03/09/2011
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Provider Practice Location Address
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Address Line | 2015 E RIVERSIDE DR BLDG 2, UNIT D
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City | AUSTIN
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State | TX
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Zip | 78741-1324
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Country | US
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Telephone | 512-652-0044
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Fax |
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Provider Business Mailing Address
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Address Line | 2515 MCKINNEY AVE SUITE 940
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City | DALLAS
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State | TX
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Zip | 75201-1908
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Country | US
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Telephone | 682-478-9117
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Fax | 817-887-2305
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Authorized Official
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Title or Position | PHYSICIAN
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Name | CANDICE ADDISON
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Credential |
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Telephone | 512-652-0044
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | N7984
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License Number State | TX
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