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General NPI Number Information
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NPI Number | 1780853200
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Entity Type | Organization
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Legal Business Name | ATLANTA MINIMALLY INVASIVE GYNECOLOGIC SURGERY CENTER,LLC
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Dates
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Enumeration Date | 02/28/2008
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Last Update Date | 03/24/2015
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Provider Practice Location Address
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Address Line | 105 COLLIER RD NW SUITE 1010
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City | ATLANTA
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State | GA
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Zip | 30309-1710
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Country | US
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Telephone | 404-355-4885
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Fax | 404-355-2210
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Provider Business Mailing Address
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Address Line | 105 COLLIER RD NW SUITE 1010
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City | ATLANTA
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State | GA
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Zip | 30309-1710
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Country | US
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Telephone | 404-355-4885
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Fax | 404-355-2210
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Authorized Official
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Title or Position | PRACTICE MANAGER
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Name | FREEDOM MITCHELL
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Credential |
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Telephone | 404-355-4885
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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 | 045895
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License Number State | GA
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