Provider Demographics
NPI:1154859817
Name:MDVIP MEDICAL GROUP GA-ATL
Entity Type:Organization
Organization Name:MDVIP MEDICAL GROUP GA-ATL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF MEDICAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:ANDREA
Authorized Official - Middle Name:
Authorized Official - Last Name:KLEMES
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:561-982-4300
Mailing Address - Street 1:1800 HOWELL MILL RD NW STE 525
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30318-3188
Mailing Address - Country:US
Mailing Address - Phone:404-537-8081
Mailing Address - Fax:404-367-3085
Practice Address - Street 1:1800 HOWELL MILL RD NW STE 525
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30318-2538
Practice Address - Country:US
Practice Address - Phone:404-537-8081
Practice Address - Fax:404-367-3085
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MDVIP MEDICAL GROUP HOLDINGS, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-05-25
Last Update Date:2023-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty