MEDICARE: ATLANTA HEALTH SYSTEM CORP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261Q00000X	Clinic/Center		GA

General Provider Information

NPI Number	:	1396290680
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ATLANTA HEALTH SYSTEM CORP

Provider Business Mailing Address
First Line	:	3348 PEACHTREE RD NE STE 700
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30326-1442
Country	:	US
Telephone Number	:	404-934-5181
Fax Number	:	470-200-0254

Provider Business Practice Location Address
First Line	:	3348 PEACHTREE RD NE STE 700
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30326-1442
Country	:	US
Telephone Number	:	404-934-5181
Fax Number	:	470-200-0254

Authorized Official
Title or Position	:	OWNER
Name	:	RAMON ABREU
Credential	:
Telephone Number	:	404-934-5181

Provider Enumeration Date	:	08/17/2016
Last Update Date	:	09/23/2016

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