Provider Demographics
NPI:1023188927
Name:ATLANTA SURGERY & TRAUMA, P.C.
Entity Type:Organization
Organization Name:ATLANTA SURGERY & TRAUMA, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:VERNON
Authorized Official - Middle Name:J
Authorized Official - Last Name:HENDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:404-688-1444
Mailing Address - Street 1:285 BOULEVARD NE
Mailing Address - Street 2:SUITE 535
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30312-4205
Mailing Address - Country:US
Mailing Address - Phone:404-688-1444
Mailing Address - Fax:404-688-1666
Practice Address - Street 1:285 BOULEVARD NE
Practice Address - Street 2:SUITE 535
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30312-4214
Practice Address - Country:US
Practice Address - Phone:404-688-1444
Practice Address - Fax:404-688-1666
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA044746208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAGRP7037Medicare ID - Type Unspecified
GAF15443Medicare UPIN