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General NPI Number Information
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NPI Number | 1316146483
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Entity Type | Organization
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Legal Business Name | ATL COLORECTAL SURGERY
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Dates
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Enumeration Date | 07/17/2007
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Last Update Date | 05/27/2008
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Provider Practice Location Address
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Address Line | 95 COLLIER RD NW SUITE 4025
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City | ATLANTA
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State | GA
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Zip | 30309-1796
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Country | US
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Telephone | 404-574-5820
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Fax | 404-574-5821
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Provider Business Mailing Address
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Address Line | 2221 PEACHTREE RD NE SUITE D442
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City | ATLANTA
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State | GA
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Zip | 30309-1148
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Country | US
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Telephone | 404-574-5820
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Fax | 619-789-6513
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Authorized Official
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Title or Position | PRES
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Name | MONICA HUM
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Credential | M. D.
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Telephone | 404-574-5820
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208C00000X
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Taxonomy Name | Colon & Rectal Surgery Physician
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License Number | 53247
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License Number State | GA
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