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General NPI Number Information
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NPI Number | 1659616589
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Entity Type | Organization
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Legal Business Name | PHYSICIAN SPECIALISTS OF ATLANTA
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Dates
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Enumeration Date | 12/04/2012
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Last Update Date | 12/04/2012
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Provider Practice Location Address
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Address Line | 100 GLENRIDGE POINT PKWY NE STE 530
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City | ATLANTA
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State | GA
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Zip | 30342-1442
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Country | US
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Telephone | 404-531-9992
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Fax | 404-531-9901
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Provider Business Mailing Address
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Address Line | PO BOX 421876
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City | ATLANTA
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State | GA
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Zip | 30342-8876
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Country | US
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Telephone | 404-531-9992
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Fax | 404-531-9901
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Authorized Official
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Title or Position | OWNER
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Name | MRS. REBECA ROSH
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Credential |
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Telephone | 404-531-9992
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number |
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License Number State | GA
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