Provider Demographics
NPI:1639459407
Name:DOWNTOWN ATLANTA MEDICAL CENTER, P.C.
Entity Type:Organization
Organization Name:DOWNTOWN ATLANTA MEDICAL CENTER, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:FREDERICK
Authorized Official - Middle Name:D
Authorized Official - Last Name:MOSER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:404-419-2050
Mailing Address - Street 1:610 NORTHSIDE DR NW
Mailing Address - Street 2:STE. B
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30318-6927
Mailing Address - Country:US
Mailing Address - Phone:404-419-2050
Mailing Address - Fax:
Practice Address - Street 1:610 NORTHSIDE DR NW
Practice Address - Street 2:STE. B
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30318-6927
Practice Address - Country:US
Practice Address - Phone:404-419-2050
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-24
Last Update Date:2011-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA23771207LP2900X, 2081P2900X, 208VP0000X, 208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Multi-Specialty
No2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain MedicineGroup - Multi-Specialty
No208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain MedicineGroup - Multi-Specialty
No208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Multi-Specialty