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General NPI Number Information
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NPI Number | 1912284480
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Entity Type | Organization
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Legal Business Name | ATLANTA CENTRAL MEDICAL GROUP, INC.
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Dates
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Enumeration Date | 11/10/2011
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Last Update Date | 11/10/2011
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Provider Practice Location Address
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Address Line | 2400 PLEASANT HILL RD 300
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City | DULUTH
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State | GA
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Zip | 30096-4396
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Country | US
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Telephone | 678-467-9882
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Fax |
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Provider Business Mailing Address
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Address Line | 5360 BEAVER BR
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City | NORCROSS
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State | GA
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Zip | 30071-4579
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Country | US
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Telephone | 678-467-9882
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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. KUY IK PARK
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Credential |
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Telephone | 678-467-9882
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171100000X
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Taxonomy Name | Acupuncturist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 2081P2900X
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Taxonomy Name | Pain Medicine (Physical Medicine & Rehabilitation) Physician
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 2083P0500X
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Taxonomy Name | Preventive Medicine/Occupational Environmental Medicine Physician
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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