Provider Demographics
NPI:1114275427
Name:ATLANTIC SOUTH MEDICAL GROUP INCORPORATED
Entity Type:Organization
Organization Name:ATLANTIC SOUTH MEDICAL GROUP INCORPORATED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:VOLRICK
Authorized Official - Middle Name:
Authorized Official - Last Name:MORRISON
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:305-931-7424
Mailing Address - Street 1:PO BOX 909
Mailing Address - Street 2:
Mailing Address - City:HALLANDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33008-0909
Mailing Address - Country:US
Mailing Address - Phone:305-931-7424
Mailing Address - Fax:305-931-7425
Practice Address - Street 1:2925 AVENTURA BLVD
Practice Address - Street 2:SUITE 101
Practice Address - City:AVENTURA
Practice Address - State:FL
Practice Address - Zip Code:33180-3124
Practice Address - Country:US
Practice Address - Phone:305-931-7424
Practice Address - Fax:305-931-7425
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-16
Last Update Date:2015-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL007960400Medicaid
FL007960400Medicaid