Provider Demographics
NPI:1326237967
Name:THE SOUTH ATLANTA CENTER FOR ENDOCRINOLOGY. LLC
Entity Type:Organization
Organization Name:THE SOUTH ATLANTA CENTER FOR ENDOCRINOLOGY. LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:SABRINA
Authorized Official - Middle Name:M-Y
Authorized Official - Last Name:RENE
Authorized Official - Suffix:
Authorized Official - Credentials:MEDICAL DOCTOR
Authorized Official - Phone:678-904-4841
Mailing Address - Street 1:484 IRVIN CT
Mailing Address - Street 2:SUITE 220
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30030-5406
Mailing Address - Country:US
Mailing Address - Phone:678-904-4841
Mailing Address - Fax:678-904-6660
Practice Address - Street 1:484 IRVIN CT
Practice Address - Street 2:SUITE 220
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30030-5406
Practice Address - Country:US
Practice Address - Phone:678-904-4841
Practice Address - Fax:678-904-6660
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-19
Last Update Date:2007-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA046560174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA46BBBGVMedicare PIN
GAH17571Medicare UPIN
GAGRP6204Medicare PIN