Provider Demographics
NPI:1376649830
Name:ATLANTIC UROLOGY PC
Entity Type:Organization
Organization Name:ATLANTIC UROLOGY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER M.D
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:MYNATT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:910-362-8765
Mailing Address - Street 1:PO BOX 30727
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28230-0727
Mailing Address - Country:US
Mailing Address - Phone:910-362-8765
Mailing Address - Fax:
Practice Address - Street 1:20 MEDICAL CAMPUS DR
Practice Address - Street 2:SUITE 202
Practice Address - City:SUPPLY
Practice Address - State:NC
Practice Address - Zip Code:28462-4096
Practice Address - Country:US
Practice Address - Phone:910-362-8765
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
2344726Medicare ID - Type Unspecified