MEDICARE: AMC/NORTH FULTON URGENT CARE 1 LLC

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	261QU0200X	Urgent Care Clinic/Center

General Provider Information

NPI Number	:	1518380914
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AMC/NORTH FULTON URGENT CARE 1 LLC

Provider Business Mailing Address
First Line	:	1234 S HAIRSTON RD
Second Line	:	SUITE 28
City	:	STONE MOUNTAIN
State	:	GA
Zip	:	30088-2719
Country	:	US
Telephone Number	:	404-292-9034
Fax Number	:	404-292-9038

Provider Business Practice Location Address
First Line	:	1234 S HAIRSTON RD
Second Line	:	SUITE 28
City	:	STONE MOUNTAIN
State	:	GA
Zip	:	30088-2719
Country	:	US
Telephone Number	:	404-292-9034
Fax Number	:	404-292-9038

Authorized Official
Title or Position	:	SVP OF OUTPATIENT SERVICES, TENET
Name	:	MR. MICHAEL KYLE BURTNETT
Credential	:
Telephone Number	:	469-893-2153

Provider Enumeration Date	:	01/22/2014
Last Update Date	:	06/08/2016

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