Provider Demographics
NPI:1497941041
Name:ADVANCED MEDICAL SPECIALIST-ATL NORCROSS
Entity Type:Organization
Organization Name:ADVANCED MEDICAL SPECIALIST-ATL NORCROSS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EVP, CMO
Authorized Official - Prefix:DR
Authorized Official - First Name:TOM
Authorized Official - Middle Name:
Authorized Official - Last Name:FOGARTY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:800-232-3550
Mailing Address - Street 1:5080 SPECTRUM DR
Mailing Address - Street 2:SUITE 1200 WEST TOWER
Mailing Address - City:ADDISON
Mailing Address - State:TX
Mailing Address - Zip Code:75001-4648
Mailing Address - Country:US
Mailing Address - Phone:800-232-3550
Mailing Address - Fax:800-401-6728
Practice Address - Street 1:6475 JIMMY CARTER BLVD STE 300
Practice Address - Street 2:
Practice Address - City:NORCROSS
Practice Address - State:GA
Practice Address - Zip Code:30071-1734
Practice Address - Country:US
Practice Address - Phone:770-242-9414
Practice Address - Fax:770-242-9746
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-18
Last Update Date:2007-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service