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General NPI Number Information
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NPI Number | 1477052835
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Entity Type | Organization
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Legal Business Name | ATLANTA COMPLETE CARE MD LLC
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Dates
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Enumeration Date | 02/12/2018
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Last Update Date | 03/19/2018
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Provider Practice Location Address
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Address Line | 1720 PEACHTREE ST NW STE 140
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City | ATLANTA
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State | GA
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Zip | 30309-2439
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Country | US
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Telephone | 404-575-1300
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Fax | 404-575-1301
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Provider Business Mailing Address
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Address Line | 1720 PEACHTREE ST NW STE 140
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City | ATLANTA
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State | GA
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Zip | 30309-2439
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Country | US
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Telephone | 404-575-1300
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Fax | 404-575-1301
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Authorized Official
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Title or Position | OWNER
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Name | DR. ROBERTO ANIBAL VARGAS
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Credential | MD
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Telephone | 404-575-1300
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | CHIR007618
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | PT010743
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License Number State | GA
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Taxonomy #3
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | RN213563
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License Number State | GA
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Taxonomy #4
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | FD3356575
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License Number State | GA
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