Provider Demographics
NPI:1003324187
Name:AMERICAN PROFESSIONAL ASSOCIATES LLC
Entity Type:Organization
Organization Name:AMERICAN PROFESSIONAL ASSOCIATES LLC
Other - Org Name:ATLANTA ONCOLOGY ASSOCIATES AT SOUTH FULTON
Other - Org Type:Other Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:L
Authorized Official - Last Name:MCCORD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-350-0126
Mailing Address - Street 1:PO BOX 745766
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-5766
Mailing Address - Country:US
Mailing Address - Phone:770-350-0126
Mailing Address - Fax:770-515-9502
Practice Address - Street 1:1136 CLEVELAND AVE STE 119
Practice Address - Street 2:
Practice Address - City:EAST POINT
Practice Address - State:GA
Practice Address - Zip Code:30344-3618
Practice Address - Country:US
Practice Address - Phone:404-522-6569
Practice Address - Fax:404-522-8265
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:AMERICAN PROFESSIONAL ASSOCIATES LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-01-11
Last Update Date:2022-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation OncologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000136903AAMedicaid