Provider Demographics
NPI:1720375728
Name:ATLANTIC MEDICAL GROUP
Entity Type:Organization
Organization Name:ATLANTIC MEDICAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:NATALIE
Authorized Official - Middle Name:
Authorized Official - Last Name:SUHANOV
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:706-504-4323
Mailing Address - Street 1:1518 MONTE SANO AVE
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30904-5323
Mailing Address - Country:US
Mailing Address - Phone:706-504-4323
Mailing Address - Fax:706-504-4325
Practice Address - Street 1:1518 MONTE SANO AVE
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30904-5323
Practice Address - Country:US
Practice Address - Phone:706-504-4323
Practice Address - Fax:706-504-4325
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-29
Last Update Date:2011-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA018190174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty