Provider Demographics
NPI:1740724848
Name:BODY LOGIC OF ATLANTA
Entity type:Organization
Organization Name:BODY LOGIC OF ATLANTA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANDREE
Authorized Official - Middle Name:NECOLE
Authorized Official - Last Name:MATTHEWS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-613-2971
Mailing Address - Street 1:2941 PIEDMONT RD NE
Mailing Address - Street 2:SUITE C
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30305-2784
Mailing Address - Country:US
Mailing Address - Phone:404-608-0376
Mailing Address - Fax:
Practice Address - Street 1:2941 PIEDMONT RD NE
Practice Address - Street 2:SUITE C
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30305-2784
Practice Address - Country:US
Practice Address - Phone:404-608-0376
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-07
Last Update Date:2016-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA46540207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty