Provider Demographics
NPI:1821769027
Name:ATLAS LLC
Entity Type:Organization
Organization Name:ATLAS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:TOMIKO
Authorized Official - Middle Name:
Authorized Official - Last Name:MCGHEE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-493-2632
Mailing Address - Street 1:2549 YUKON PL
Mailing Address - Street 2:
Mailing Address - City:SPEARFISH
Mailing Address - State:SD
Mailing Address - Zip Code:57783-8531
Mailing Address - Country:US
Mailing Address - Phone:605-549-1212
Mailing Address - Fax:605-549-1313
Practice Address - Street 1:2549 YUKON PL
Practice Address - Street 2:
Practice Address - City:SPEARFISH
Practice Address - State:SD
Practice Address - Zip Code:57783-8531
Practice Address - Country:US
Practice Address - Phone:605-549-1212
Practice Address - Fax:605-549-1313
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-27
Last Update Date:2021-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty