Provider Demographics
NPI:1518380914
Name:AMC/NORTH FULTON URGENT CARE 1 LLC
Entity Type:Organization
Organization Name:AMC/NORTH FULTON URGENT CARE 1 LLC
Other - Org Name:MEDPOST URGENT CARE - STONE MOUNTAIN
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SVP OF OUTPATIENT SERVICES, TENET
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:KYLE
Authorized Official - Last Name:BURTNETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:469-893-2153
Mailing Address - Street 1:1234 S HAIRSTON RD
Mailing Address - Street 2:SUITE 28
Mailing Address - City:STONE MOUNTAIN
Mailing Address - State:GA
Mailing Address - Zip Code:30088-2719
Mailing Address - Country:US
Mailing Address - Phone:404-292-9034
Mailing Address - Fax:404-292-9038
Practice Address - Street 1:1234 S HAIRSTON RD
Practice Address - Street 2:SUITE 28
Practice Address - City:STONE MOUNTAIN
Practice Address - State:GA
Practice Address - Zip Code:30088-2719
Practice Address - Country:US
Practice Address - Phone:404-292-9034
Practice Address - Fax:404-292-9038
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-22
Last Update Date:2016-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care