Provider Demographics
NPI:1649775792
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:Doing Business As
Authorized Official - Title/Position:PRACTICE ADMINSITRATOR
Authorized Official - Prefix:
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:HOPPER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-883-7960
Mailing Address - Street 1:275 COLLIER RD NW STE 450
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30309-1748
Mailing Address - Country:US
Mailing Address - Phone:404-355-3161
Mailing Address - Fax:404-355-1353
Practice Address - Street 1:1265 HIGHWAY 54 W STE 500C
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30214-4537
Practice Address - Country:US
Practice Address - Phone:678-435-3040
Practice Address - Fax:678-435-3044
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-29
Last Update Date:2018-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA300033798CMedicaid