Provider Demographics
NPI:1689063554
Name:ATL COLORECTAL SURGERY
Entity Type:Organization
Organization Name:ATL COLORECTAL SURGERY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAN/ MANAGING PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:MONICA
Authorized Official - Middle Name:
Authorized Official - Last Name:HUM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:404-574-5820
Mailing Address - Street 1:95 COLLIER RD NW
Mailing Address - Street 2:SUITE 4025
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30309
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:95 COLLIER RD NW
Practice Address - Street 2:SUITE 4025
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30309-1796
Practice Address - Country:US
Practice Address - Phone:404-574-5820
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-15
Last Update Date:2015-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital