Provider Demographics
NPI:1114377025
Name:ATLANTA CLINICAL RESEARCH CENTERS LLC
Entity Type:Organization
Organization Name:ATLANTA CLINICAL RESEARCH CENTERS LLC
Other - Org Name:GEORGIA CARDIOVASCULAR AND PRIMARY CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:BOBBY
Authorized Official - Middle Name:V
Authorized Official - Last Name:KHAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD, PHD
Authorized Official - Phone:404-600-4343
Mailing Address - Street 1:5671 PEACHTREE DUNWOODY RD STE 550
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30342-5013
Mailing Address - Country:US
Mailing Address - Phone:404-296-1130
Mailing Address - Fax:404-600-4466
Practice Address - Street 1:11680 GREAT OAKS WAY STE 170
Practice Address - Street 2:
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30022-2483
Practice Address - Country:US
Practice Address - Phone:404-296-1130
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-21
Last Update Date:2022-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00612554CMedicaid
11BDLNB01Medicare PIN
GA00612554CMedicaid