Provider Demographics
NPI:1497995518
Name:ATLANTIC UROLOGY PC
Entity Type:Organization
Organization Name:ATLANTIC UROLOGY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:J
Authorized Official - Last Name:MYNATT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:910-362-8765
Mailing Address - Street 1:PO BOX 600085
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27675-6085
Mailing Address - Country:US
Mailing Address - Phone:910-362-8765
Mailing Address - Fax:
Practice Address - Street 1:14905 US HIGHWAY 17 N
Practice Address - Street 2:
Practice Address - City:HAMPSTEAD
Practice Address - State:NC
Practice Address - Zip Code:28443-3391
Practice Address - Country:US
Practice Address - Phone:910-270-0994
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-02
Last Update Date:2009-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty