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General NPI Number Information
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NPI Number | 1609146547
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Entity Type | Organization
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Legal Business Name | ATLANTA MEDICAL DAY SPA
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Dates
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Enumeration Date | 01/10/2012
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Last Update Date | 10/18/2012
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Provider Practice Location Address
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Address Line | 3275 PEACHTREE ROAD SUITE 250
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City | ATLANTA
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State | GA
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Zip | 30305
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Country | US
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Telephone | 678-213-2220
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Fax | 678-235-2223
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Provider Business Mailing Address
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Address Line | 1232 JOHNSON FERRY RD
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City | MARIETTA
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State | GA
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Zip | 30068-2776
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Country | US
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Telephone | 678-213-2220
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Fax | 678-213-3331
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Authorized Official
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Title or Position | OWNER
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Name | DEBRA J ATKINS
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Credential | M.D.
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Telephone | 678-213-2220
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | 052052
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License Number State | GA
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