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General NPI Number Information
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NPI Number | 1720375728
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Entity Type | Organization
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Legal Business Name | ATLANTIC MEDICAL GROUP
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Dates
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Enumeration Date | 06/29/2011
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Last Update Date | 06/29/2011
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Provider Practice Location Address
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Address Line | 1518 MONTE SANO AVE
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City | AUGUSTA
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State | GA
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Zip | 30904-5323
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Country | US
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Telephone | 706-504-4323
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Fax | 706-504-4325
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Provider Business Mailing Address
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Address Line | 1518 MONTE SANO AVE
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City | AUGUSTA
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State | GA
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Zip | 30904-5323
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Country | US
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Telephone | 706-504-4323
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Fax | 706-504-4325
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Authorized Official
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Title or Position | OWNER
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Name | MRS. NATALIE SUHANOV
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Credential |
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Telephone | 706-504-4323
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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 | 018190
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License Number State | GA
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