MEDICARE: ATLANTIC UROLOGICAL ASSOCIATES P A

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	208800000X	Urology Physician

General Provider Information

NPI Number	:	1881815561
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ATLANTIC UROLOGICAL ASSOCIATES P A

Provider Business Mailing Address
First Line	:	545 HEALTH BLVD
Second Line	:
City	:	DAYTONA BEACH
State	:	FL
Zip	:	32114-1493
Country	:	US
Telephone Number	:	386-239-8500
Fax Number	:

Provider Business Practice Location Address
First Line	:	506 PALMETTO ST
Second Line	:
City	:	NEW SMYRNA BEACH
State	:	FL
Zip	:	32168-7325
Country	:	US
Telephone Number	:	386-427-9554
Fax Number	:

Authorized Official
Title or Position	:	CHIEF OPERATING OFFICER
Name	:	JERRI CREGGAR
Credential	:
Telephone Number	:	386-239-8500

Provider Enumeration Date	:	05/01/2007
Last Update Date	:	02/14/2008

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