Provider Demographics
NPI:1598781635
Name:ATLANTA MEDICAL CENTER, INC.
Entity Type:Organization
Organization Name:ATLANTA MEDICAL CENTER, INC.
Other - Org Name:ATLANTA MEDICAL CENTER- SOUTH CAMPUS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:T
Authorized Official - Last Name:MOORE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-256-4000
Mailing Address - Street 1:PO BOX 741252
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-1252
Mailing Address - Country:US
Mailing Address - Phone:678-242-2002
Mailing Address - Fax:678-242-2202
Practice Address - Street 1:1170 CLEVELAND AVE
Practice Address - Street 2:
Practice Address - City:EAST POINT
Practice Address - State:GA
Practice Address - Zip Code:30344-3615
Practice Address - Country:US
Practice Address - Phone:404-466-1170
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-14
Last Update Date:2022-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA060-598282N00000X
341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
No341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1708445Medicaid
181713800OtherVISTA HEALTH PLAN HMO/POS
979062670OtherAETNA US HEALTHCARE (NATI
100054OtherBCBS OF GEORGIA
GA300042914AMedicaid
NY00382509Medicaid
MS08500709Medicaid
109906OtherCOVENTRY HEALTH CARE GEOR
75-2918809OtherTENET EMPLOYEES BENEFIT P
OH0542792Medicaid
110219B000000OtherSECTION 1011
GA300042914AMedicaid