Provider Demographics
NPI:1093013385
Name:MEDICAL TREATMENT CENTERS OF AMERICA, INC
Entity Type:Organization
Organization Name:MEDICAL TREATMENT CENTERS OF AMERICA, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:OFFER
Authorized Official - Middle Name:
Authorized Official - Last Name:DANAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-695-5500
Mailing Address - Street 1:3636 SATELLITE BLVD
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:GA
Mailing Address - Zip Code:30096-4590
Mailing Address - Country:US
Mailing Address - Phone:404-448-2012
Mailing Address - Fax:800-814-3301
Practice Address - Street 1:3636 SATELLITE BLVD
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:GA
Practice Address - Zip Code:30096-4590
Practice Address - Country:US
Practice Address - Phone:404-448-2012
Practice Address - Fax:800-814-3301
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-10
Last Update Date:2011-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA053868261QM1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty