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General NPI Number Information
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NPI Number | 1902559909
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Entity Type | Organization
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Legal Business Name | SUD MEDICAL GROUP, LLC
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Dates
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Enumeration Date | 01/31/2022
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Last Update Date | 01/31/2022
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Provider Practice Location Address
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Address Line | 2285 PEACHTREE RD NE STE 210B
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City | ATLANTA
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State | GA
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Zip | 30309-1121
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Country | US
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Telephone | 404-333-2277
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Fax |
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Provider Business Mailing Address
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Address Line | 2285 PEACHTREE RD NE STE 210B
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City | ATLANTA
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State | GA
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Zip | 30309-1121
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Country | US
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Telephone | 404-333-2277
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | MR. CARTER D POPE JR.
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Credential |
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Telephone | 404-333-2277
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0405X
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Taxonomy Name | Substance Use Disorder Rehabilitation Clinic/Center
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License Number |
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License Number State |
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