Provider Demographics
NPI:1093074551
Name:MTN HEALTHCARE GROUP, LLC
Entity Type:Organization
Organization Name:MTN HEALTHCARE GROUP, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:CESAR
Authorized Official - Middle Name:AUGUSTO
Authorized Official - Last Name:MAZZOTTA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-817-4117
Mailing Address - Street 1:1117 PERIMETER CTR W
Mailing Address - Street 2:SUITE N404
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30338-5451
Mailing Address - Country:US
Mailing Address - Phone:770-817-4117
Mailing Address - Fax:770-817-4105
Practice Address - Street 1:1117 PERIMETER CTR W
Practice Address - Street 2:SUITE N404
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30338-5451
Practice Address - Country:US
Practice Address - Phone:770-817-4117
Practice Address - Fax:770-817-4105
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-03
Last Update Date:2012-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
No2080P0205XAllopathic & Osteopathic PhysiciansPediatricsPediatric EndocrinologyGroup - Multi-Specialty
No2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent PsychiatryGroup - Multi-Specialty