Provider Demographics
NPI:1568485134
Name:LOGAN, ARIKE (MD)
Entity Type:Individual
Prefix:DR
First Name:ARIKE
Middle Name:
Last Name:LOGAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5270 PEACHTREE PKWY
Mailing Address - Street 2:SUITE 116
Mailing Address - City:NORCROSS
Mailing Address - State:GA
Mailing Address - Zip Code:30092-6510
Mailing Address - Country:US
Mailing Address - Phone:770-446-6789
Mailing Address - Fax:770-446-7879
Practice Address - Street 1:1395 S MARIETTA PKWY SE
Practice Address - Street 2:BLDG 100 STE 101
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30067-4440
Practice Address - Country:US
Practice Address - Phone:770-425-8700
Practice Address - Fax:770-425-8740
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2010-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA031466207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAGRP6996OtherGROUP INFO
GA031466OtherSTATE LICENSE
GABL1754844Medicaid
GAGRP6996OtherGROUP INFO
08BBXQTMedicare ID - Type Unspecified