Provider Demographics
NPI:1497836456
Name:ARTHRITIS RESEARCH & TREATMENT CENTER
Entity Type:Organization
Organization Name:ARTHRITIS RESEARCH & TREATMENT CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:
Authorized Official - Last Name:FONDAL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:678-289-5488
Mailing Address - Street 1:1101 HOSPITAL DRIVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:STOCKBRIDGE
Mailing Address - State:GA
Mailing Address - Zip Code:30281-9075
Mailing Address - Country:US
Mailing Address - Phone:678-289-5488
Mailing Address - Fax:678-289-5489
Practice Address - Street 1:1101 HOSPITAL DR
Practice Address - Street 2:SUITE 200
Practice Address - City:STOCKBRIDGE
Practice Address - State:GA
Practice Address - Zip Code:30281-9075
Practice Address - Country:US
Practice Address - Phone:678-289-5488
Practice Address - Fax:678-289-5489
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-18
Last Update Date:2010-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA045463207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA849274OtherBCBSGA
GA000790732BMedicaid
GA000790732BMedicaid
GA66BBBHBMedicare PIN
GAGRP6833Medicare PIN
GAP00174153Medicare PIN