Provider Demographics
NPI:1275875213
Name:MEDICAL CENTERS OF ATLANTA LLC
Entity Type:Organization
Organization Name:MEDICAL CENTERS OF ATLANTA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DANA
Authorized Official - Middle Name:
Authorized Official - Last Name:PICCIRILLO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:770-934-4233
Mailing Address - Street 1:PO BOX 267
Mailing Address - Street 2:
Mailing Address - City:TUCKER
Mailing Address - State:GA
Mailing Address - Zip Code:30085-0267
Mailing Address - Country:US
Mailing Address - Phone:770-934-4233
Mailing Address - Fax:770-934-4234
Practice Address - Street 1:5000 CAROL B MATHEWS LN
Practice Address - Street 2:
Practice Address - City:ROSWELL
Practice Address - State:GA
Practice Address - Zip Code:30076-3293
Practice Address - Country:US
Practice Address - Phone:770-934-4233
Practice Address - Fax:770-934-4234
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-16
Last Update Date:2013-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty