Provider Demographics
NPI:1821249681
Name:SATELLITE MEDICAL GROUP, LLC
Entity Type:Organization
Organization Name:SATELLITE MEDICAL GROUP, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINIC DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:AARON
Authorized Official - Middle Name:F
Authorized Official - Last Name:SUI
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:770-710-8539
Mailing Address - Street 1:2205 LAVISTA RD NE
Mailing Address - Street 2:SUITE G
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30329-3951
Mailing Address - Country:US
Mailing Address - Phone:404-325-9877
Mailing Address - Fax:404-325-9875
Practice Address - Street 1:2205 LAVISTA RD NE
Practice Address - Street 2:SUITE G
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30329-3951
Practice Address - Country:US
Practice Address - Phone:404-325-9877
Practice Address - Fax:404-325-9875
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-09
Last Update Date:2010-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR008322111N00000X
GA149171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty
No111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty