Provider Demographics
NPI:1598954281
Name:ATLANTA HEALTH UNLIMITED
Entity Type:Organization
Organization Name:ATLANTA HEALTH UNLIMITED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:A
Authorized Official - Last Name:ALVAREZ
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:404-241-5121
Mailing Address - Street 1:3424 FLAT SHOALS RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30034-6525
Mailing Address - Country:US
Mailing Address - Phone:404-241-5121
Mailing Address - Fax:404-241-9388
Practice Address - Street 1:3424 FLAT SHOALS RD
Practice Address - Street 2:SUITE B
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30034-6525
Practice Address - Country:US
Practice Address - Phone:404-241-5121
Practice Address - Fax:404-241-9388
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-18
Last Update Date:2008-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA005496261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00970912AMedicaid
GA35ZCDRRMedicare PIN
GAU65322Medicare UPIN
GA2908Medicare PIN