MEDICARE: ATLANTA METROPOLITAN MEDICAL SERVICES 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	251S00000X	Community/Behavioral Health Agency	RN175200	GA

General Provider Information

NPI Number	:	1750821203
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ATLANTA METROPOLITAN MEDICAL SERVICES LLC

Provider Business Mailing Address
First Line	:	1385 LAKEBOAT WAY SW
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30331-8936
Country	:	US
Telephone Number	:	404-492-2098
Fax Number	:

Provider Business Practice Location Address
First Line	:	1385 LAKEBOAT WAY SW
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30331-8936
Country	:	US
Telephone Number	:	404-492-2098
Fax Number	:

Authorized Official
Title or Position	:	BEHAVORIAL HEALTH NURSE
Name	:	MARSHA A GREEN
Credential	:	REGISTERED NURSE
Telephone Number	:	404-492-2098

Provider Enumeration Date	:	03/02/2017
Last Update Date	:	03/02/2017

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