Provider Demographics
NPI:1851172019
Name:ATLANTIC COVE MEDICAL GROUP, LLC
Entity Type:Organization
Organization Name:ATLANTIC COVE MEDICAL GROUP, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:COLLINS
Authorized Official - Middle Name:
Authorized Official - Last Name:EZEUKA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:941-208-3070
Mailing Address - Street 1:5342 CLARK RD # 3072
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34233-3227
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1949 NORTHGATE BLVD
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34234-2143
Practice Address - Country:US
Practice Address - Phone:941-208-3070
Practice Address - Fax:941-208-3067
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-12
Last Update Date:2023-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty