Provider Demographics
NPI:1669471728
Name:ATLANTA CENTER FOR MEDICINE II PC
Entity Type:Organization
Organization Name:ATLANTA CENTER FOR MEDICINE II PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MAUREEN
Authorized Official - Middle Name:
Authorized Official - Last Name:CARPENTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-296-3111
Mailing Address - Street 1:2801 N DECATUR RD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30033-5949
Mailing Address - Country:US
Mailing Address - Phone:404-296-3111
Mailing Address - Fax:404-297-7340
Practice Address - Street 1:2801 N DECATUR RD
Practice Address - Street 2:SUITE 300
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30033-5949
Practice Address - Country:US
Practice Address - Phone:404-296-3111
Practice Address - Fax:404-297-7340
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-20
Last Update Date:2015-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA055003002AMedicaid
X24220Medicare UPIN
GAGRP2984Medicare ID - Type Unspecified