Provider Demographics
NPI:1477052835
Name:ATLANTA COMPLETE CARE MD LLC
Entity Type:Organization
Organization Name:ATLANTA COMPLETE CARE MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERTO
Authorized Official - Middle Name:ANIBAL
Authorized Official - Last Name:VARGAS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:404-575-1300
Mailing Address - Street 1:1720 PEACHTREE ST NW STE 140
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30309-2439
Mailing Address - Country:US
Mailing Address - Phone:404-575-1300
Mailing Address - Fax:404-575-1301
Practice Address - Street 1:1720 PEACHTREE ST NW STE 140
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30309-2439
Practice Address - Country:US
Practice Address - Phone:404-575-1300
Practice Address - Fax:404-575-1301
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-12
Last Update Date:2018-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR007618111N00000X
GAFD3356575207Q00000X
GAPT010743225100000X
GARN213563363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty