Provider Demographics
NPI:1407012586
Name:CRITICAL CARE ATLANTA, LLC
Entity Type:Organization
Organization Name:CRITICAL CARE ATLANTA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:
Authorized Official - Last Name:MELBY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:404-252-7200
Mailing Address - Street 1:5667 PEACHTREE DUNWOODY RD NE
Mailing Address - Street 2:SUITE 350
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30342-1725
Mailing Address - Country:US
Mailing Address - Phone:404-252-7200
Mailing Address - Fax:404-252-6780
Practice Address - Street 1:5667 PEACHTREE DUNWOODY RD NE
Practice Address - Street 2:SUITE 350
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30342-1725
Practice Address - Country:US
Practice Address - Phone:404-252-7200
Practice Address - Fax:404-252-6780
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-29
Last Update Date:2008-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA207RC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care MedicineGroup - Single Specialty