Provider Demographics
NPI:1083713259
Name:ATLANTA CLINICAL CARE PC
Entity Type:Organization
Organization Name:ATLANTA CLINICAL CARE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:I
Authorized Official - Last Name:MARLOWE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:404-459-0002
Mailing Address - Street 1:5673 PEACHTREE DUNWOODY RD STE 330
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30342-1774
Mailing Address - Country:US
Mailing Address - Phone:404-459-0002
Mailing Address - Fax:404-459-0003
Practice Address - Street 1:5673 PEACHTREE DUNWOODY RD STE 330
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30342-1774
Practice Address - Country:US
Practice Address - Phone:404-459-0002
Practice Address - Fax:404-459-0003
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-22
Last Update Date:2010-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA027866207RI0200X
GA047984207RI0200X
GA052804207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious DiseaseGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GADB3747OtherMEDICARE RAILROAD
GA6308610001Medicare NSC
GRP 1626Medicare ID - Type Unspecified