Provider Demographics
NPI:1275816472
Name:SURGICAL & BARIATRIC ASSOCIATES OF ATLANTA MEDICAL CENTER, LLC
Entity Type:Organization
Organization Name:SURGICAL & BARIATRIC ASSOCIATES OF ATLANTA MEDICAL CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SVP OF OUTPATIENT SERVICES, TENET
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:KYLE
Authorized Official - Last Name:USE MICHAEL 'KYLE' K. BURTNETT; SVP
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:469-893-2153
Mailing Address - Street 1:PO BOX 741863
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-1863
Mailing Address - Country:US
Mailing Address - Phone:404-881-8020
Mailing Address - Fax:678-553-3179
Practice Address - Street 1:285 BOULEVARD NE
Practice Address - Street 2:SUITE 120
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30312-4205
Practice Address - Country:US
Practice Address - Phone:404-881-8020
Practice Address - Fax:678-553-3179
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-23
Last Update Date:2016-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty