Provider Demographics
NPI:1689881989
Name:INFECTIOUS DISEASES ASSOCIATES, PC
Entity Type:Organization
Organization Name:INFECTIOUS DISEASES ASSOCIATES, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:PAM
Authorized Official - Middle Name:
Authorized Official - Last Name:TEMPLETON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-991-1500
Mailing Address - Street 1:6285 GARDEN WALK BLVD
Mailing Address - Street 2:STE A
Mailing Address - City:RIVERDALE
Mailing Address - State:GA
Mailing Address - Zip Code:30274-2612
Mailing Address - Country:US
Mailing Address - Phone:770-991-1500
Mailing Address - Fax:770-991-9047
Practice Address - Street 1:6285 GARDEN WALK BLVD
Practice Address - Street 2:STE A
Practice Address - City:RIVERDALE
Practice Address - State:GA
Practice Address - Zip Code:30274-2612
Practice Address - Country:US
Practice Address - Phone:770-991-1500
Practice Address - Fax:770-991-9047
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-17
Last Update Date:2011-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA63616207RI0200X
GA019754207RI0200X
GA020689207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA1427064583OtherNPI
GA1548276603OtherNPI
1538216338OtherNPI