Provider Demographics
NPI:1548767619
Name:ATLANTA ID GROUP, P.C.
Entity Type:Organization
Organization Name:ATLANTA ID GROUP, P.C.
Other - Org Name:INFECTIOUS DISEASE SOLUTIONS
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:CEO/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTINE
Authorized Official - Middle Name:A
Authorized Official - Last Name:ZURAWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:404-351-8873
Mailing Address - Street 1:275 COLLIER RD
Mailing Address - Street 2:SUITE450
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30309
Mailing Address - Country:US
Mailing Address - Phone:404-351-8871
Mailing Address - Fax:404-355-1353
Practice Address - Street 1:1265 HIGHWAY 54 WEST
Practice Address - Street 2:SUITE 500-C
Practice Address - City:FAYETTEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30214
Practice Address - Country:US
Practice Address - Phone:678-435-3040
Practice Address - Fax:678-435-3044
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ATLANTA ID GROUP, P.C.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-04-06
Last Update Date:2018-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPHRE009501333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy