Provider Demographics
NPI:1447404835
Name:ATLANTA HOPE MEDICAL GROUP INC
Entity Type:Organization
Organization Name:ATLANTA HOPE MEDICAL GROUP INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:SONG
Authorized Official - Middle Name:
Authorized Official - Last Name:CUI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:648-205-2670
Mailing Address - Street 1:2830 CLEARVIEW PL
Mailing Address - Street 2:SUITE 500
Mailing Address - City:DORAVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30340-2134
Mailing Address - Country:US
Mailing Address - Phone:678-205-2670
Mailing Address - Fax:678-205-2671
Practice Address - Street 1:2830 CLEARVIEW PLACE
Practice Address - Street 2:SUITE 500
Practice Address - City:DORAVILLE
Practice Address - State:GA
Practice Address - Zip Code:30340-2134
Practice Address - Country:US
Practice Address - Phone:678-205-2670
Practice Address - Fax:678-205-2671
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-11
Last Update Date:2009-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA202G704141Medicare PIN