MEDICARE: DOWNTOWN ATLANTA MEDICAL CENTER, P.C.

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	2081P2900X	Pain Medicine (Physical Medicine & Rehabilitation) Physician	23771	GA
2	208VP0000X	Pain Medicine Physician	23771	GA
3	208VP0014X	Interventional Pain Medicine Physician	23771	GA
4	207LP2900X	Pain Medicine (Anesthesiology) Physician	23771	GA

General Provider Information

NPI Number	:	1639459407
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DOWNTOWN ATLANTA MEDICAL CENTER, P.C.

Provider Business Mailing Address
First Line	:	610 NORTHSIDE DR NW
Second Line	:	STE. B
City	:	ATLANTA
State	:	GA
Zip	:	30318-6927
Country	:	US
Telephone Number	:	404-419-2050
Fax Number	:

Provider Business Practice Location Address
First Line	:	610 NORTHSIDE DR NW
Second Line	:	STE. B
City	:	ATLANTA
State	:	GA
Zip	:	30318-6927
Country	:	US
Telephone Number	:	404-419-2050
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. FREDERICK D. MOSER
Credential	:	M.D.
Telephone Number	:	404-419-2050

Provider Enumeration Date	:	08/24/2011
Last Update Date	:	08/24/2011

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