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General NPI Number Information
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NPI Number | 1487923744
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Entity Type | Organization
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Legal Business Name | LATINAMERICAN MEDICAL CENTER
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Dates
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Enumeration Date | 12/15/2011
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Last Update Date | 12/15/2011
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Provider Practice Location Address
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Address Line | 2841 BUFORD HWY NE
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City | ATLANTA
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State | GA
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Zip | 30329-2101
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Country | US
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Telephone | 404-321-5151
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Fax | 404-321-5501
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Provider Business Mailing Address
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Address Line | 2841 BUFORD HWY NE
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City | ATLANTA
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State | GA
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Zip | 30329-2101
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Country | US
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Telephone | 404-321-5151
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Fax | 404-321-5501
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Authorized Official
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Title or Position | OWNER
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Name | DR. JAIME HERNAN SACOTTO
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Credential | MD
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Telephone | 404-321-5151
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | 045606
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License Number State | GA
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