Provider Demographics
NPI:1619944279
Name:ATLANTA I.D. GROUP, P.C.
Entity Type:Organization
Organization Name:ATLANTA I.D. GROUP, P.C.
Other - Org Name:INFECTIOUS DISEASE SOLUTIONS
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CARLOS
Authorized Official - Middle Name:E
Authorized Official - Last Name:LOPEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:404-355-3161
Mailing Address - Street 1:2001 PEACHTREE RD NE
Mailing Address - Street 2:SUITE 640
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30309-1476
Mailing Address - Country:US
Mailing Address - Phone:404-355-3161
Mailing Address - Fax:404-355-1353
Practice Address - Street 1:2001 PEACHTREE RD NE
Practice Address - Street 2:SUITE 640
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30309-1476
Practice Address - Country:US
Practice Address - Phone:404-355-3161
Practice Address - Fax:404-355-1353
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-02
Last Update Date:2011-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA19066207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00211373BMedicaid
GA00466738BMedicaid
GA00466738BMedicaid
GA44ZCBBZMedicare PIN
GAG60856Medicare UPIN
GAE83806Medicare UPIN
GAD40483Medicare UPIN
GA44ZCBMFMedicare PIN