Provider Demographics
NPI:1043225758
Name:CSA OF ATLANTA, LLC
Entity Type:Organization
Organization Name:CSA OF ATLANTA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS
Authorized Official - Prefix:MS
Authorized Official - First Name:VICKY
Authorized Official - Middle Name:B
Authorized Official - Last Name:CARROLL
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:678-735-3201
Mailing Address - Street 1:1140 HAMMOND DR NE STE K
Mailing Address - Street 2:SUITE 350
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30328-7274
Mailing Address - Country:US
Mailing Address - Phone:678-735-3201
Mailing Address - Fax:678-735-3207
Practice Address - Street 1:1140 HAMMOND DR NE STE K
Practice Address - Street 2:SUITE 350
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30328-7274
Practice Address - Country:US
Practice Address - Phone:678-735-3201
Practice Address - Fax:678-735-3207
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-30
Last Update Date:2010-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GABL04-03274261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center