Provider Demographics
NPI:1245400514
Name:BUCKHEAD CONCIERGE INTERNAL MEDICINE, LLC
Entity Type:Organization
Organization Name:BUCKHEAD CONCIERGE INTERNAL MEDICINE, LLC
Other - Org Name:BUCKHEAD MEDICINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSICIAN OWNER
Authorized Official - Prefix:
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:ANTONIO
Authorized Official - Last Name:ESPINOSA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:404-257-5585
Mailing Address - Street 1:91 W WIEUCA RD NE
Mailing Address - Street 2:SUITE 1000
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30342-3248
Mailing Address - Country:US
Mailing Address - Phone:404-257-5585
Mailing Address - Fax:
Practice Address - Street 1:91 W WIEUCA RD NE
Practice Address - Street 2:SUITE 1000
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30342-3248
Practice Address - Country:US
Practice Address - Phone:404-257-5585
Practice Address - Fax:404-257-9985
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-03
Last Update Date:2018-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA059636207R00000X
GA59636207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty