Provider Demographics
NPI:1366624520
Name:SOUTH ATLANTA MEDICAL ASSOCIATES, PC
Entity Type:Organization
Organization Name:SOUTH ATLANTA MEDICAL ASSOCIATES, PC
Other - Org Name:SAMUEL C. ERINNE MD
Other - Org Type:Other Name
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:NICKY
Authorized Official - Middle Name:
Authorized Official - Last Name:BATTLE-BASHIR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-768-4626
Mailing Address - Street 1:1029 CLEVELAND AVE
Mailing Address - Street 2:
Mailing Address - City:EAST POINT
Mailing Address - State:GA
Mailing Address - Zip Code:30344-6719
Mailing Address - Country:US
Mailing Address - Phone:404-768-4626
Mailing Address - Fax:404-768-4631
Practice Address - Street 1:1029 CLEVELAND AVE
Practice Address - Street 2:
Practice Address - City:EAST POINT
Practice Address - State:GA
Practice Address - Zip Code:30344-6719
Practice Address - Country:US
Practice Address - Phone:404-768-4626
Practice Address - Fax:404-768-4631
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-29
Last Update Date:2012-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA035622207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00508483GMedicaid
GAF31881Medicare UPIN
GA00508483GMedicaid