Provider Demographics
NPI:1164697892
Name:ATLANTA UROLOGY ASSOCIATES, P.C.
Entity Type:Organization
Organization Name:ATLANTA UROLOGY ASSOCIATES, P.C.
Other - Org Name:BRUCE STEIN, M.D., P.C.
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:BRUCE
Authorized Official - Middle Name:
Authorized Official - Last Name:STEIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:404-525-5567
Mailing Address - Street 1:PO BOX 54676
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30308-0676
Mailing Address - Country:US
Mailing Address - Phone:404-525-5567
Mailing Address - Fax:404-880-0192
Practice Address - Street 1:550 PEACHTREE ST NE
Practice Address - Street 2:SUITE 1635
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30308-2247
Practice Address - Country:US
Practice Address - Phone:404-525-5567
Practice Address - Fax:404-880-0192
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-24
Last Update Date:2009-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA029535208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA55002324AMedicaid
GA340002347OtherRR MEDICARE
GA340002347OtherRR MEDICARE