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General NPI Number Information
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NPI Number | 1720318306
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Entity Type | Organization
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Legal Business Name | R MICHAEL PRUDENT LLC
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Dates
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Enumeration Date | 01/05/2010
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Last Update Date | 01/05/2010
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Provider Practice Location Address
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Address Line | 675 SEMINOLE AVE NE SUITE 305
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City | ATLANTA
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State | GA
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Zip | 30307-3408
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Country | US
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Telephone | 404-685-3113
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Fax | 404-601-4494
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Provider Business Mailing Address
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Address Line | 675 SEMINOLE AVE NE SUITE 305
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City | ATLANTA
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State | GA
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Zip | 30307-3408
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Country | US
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Telephone | 404-685-3113
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Fax | 404-601-4494
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Authorized Official
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Title or Position | OWNER
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Name | DR. ROBERT MICHAEL PRUDENT
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Credential | MD
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Telephone | 404-685-3113
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 037340
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License Number State | GA
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