Provider Demographics
NPI:1558679332
Name:ATLANTA ACCIDENT & INJURY SPECIALIST
Entity Type:Organization
Organization Name:ATLANTA ACCIDENT & INJURY SPECIALIST
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DANA
Authorized Official - Middle Name:GENE
Authorized Official - Last Name:PICCIRILLO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:770-934-4233
Mailing Address - Street 1:P.O. BOX 267
Mailing Address - Street 2:
Mailing Address - City:TUCKER
Mailing Address - State:GA
Mailing Address - Zip Code:30085
Mailing Address - Country:US
Mailing Address - Phone:770-934-4233
Mailing Address - Fax:
Practice Address - Street 1:2181 NORTHLAKE PKWY. SUITE 120 BLDG 6
Practice Address - Street 2:
Practice Address - City:TUCKER
Practice Address - State:GA
Practice Address - Zip Code:30084
Practice Address - Country:US
Practice Address - Phone:770-934-4233
Practice Address - Fax:770-934-4234
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-15
Last Update Date:2010-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIRO07460111N00000X
GA038164207R00000X
GA30996208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
No111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty