Provider Demographics
NPI:1609146547
Name:ATLANTA MEDICAL DAY SPA
Entity Type:Organization
Organization Name:ATLANTA MEDICAL DAY SPA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DEBRA
Authorized Official - Middle Name:J
Authorized Official - Last Name:ATKINS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:678-213-2220
Mailing Address - Street 1:1232 JOHNSON FERRY RD
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30068-2776
Mailing Address - Country:US
Mailing Address - Phone:678-213-2220
Mailing Address - Fax:678-213-3331
Practice Address - Street 1:3275 PEACHTREE ROAD
Practice Address - Street 2:SUITE 250
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30305
Practice Address - Country:US
Practice Address - Phone:678-213-2220
Practice Address - Fax:678-235-2223
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-10
Last Update Date:2012-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA052052208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty