Provider Demographics
NPI:1750862389
Name:PEDIATRIC AND ADULT SURGERY CENTER OF ATLANTA LLC
Entity Type:Organization
Organization Name:PEDIATRIC AND ADULT SURGERY CENTER OF ATLANTA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:SHATUL
Authorized Official - Middle Name:
Authorized Official - Last Name:PARIKH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:678-483-8833
Mailing Address - Street 1:960 WOODSTOCK PKWY STE 101
Mailing Address - Street 2:
Mailing Address - City:WOODSTOCK
Mailing Address - State:GA
Mailing Address - Zip Code:30188-4866
Mailing Address - Country:US
Mailing Address - Phone:678-483-8833
Mailing Address - Fax:678-483-8809
Practice Address - Street 1:2061 PEACHTREE RD NE STE 300-A
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30309-1447
Practice Address - Country:US
Practice Address - Phone:678-483-8833
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-22
Last Update Date:2018-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA055430261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical