Provider Demographics
NPI:1134495757
Name:MEDICAL CENTERS OF ATLANTA II, LLC
Entity Type:Organization
Organization Name:MEDICAL CENTERS OF ATLANTA II, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DANA
Authorized Official - Middle Name:G
Authorized Official - Last Name:PICCIRILLO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:770-650-0570
Mailing Address - Street 1:PO BOX 267
Mailing Address - Street 2:
Mailing Address - City:TUCKER
Mailing Address - State:GA
Mailing Address - Zip Code:30085
Mailing Address - Country:US
Mailing Address - Phone:770-650-0570
Mailing Address - Fax:770-650-0790
Practice Address - Street 1:2750 HOLCOMB BRIDGE RD
Practice Address - Street 2:SUITE 100
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30022-1804
Practice Address - Country:US
Practice Address - Phone:770-650-0570
Practice Address - Fax:770-650-0790
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-28
Last Update Date:2012-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty