Provider Demographics
NPI:1851457741
Name:ATLANTA MULTI-SPECIALTY ASSOCIATES, PC
Entity Type:Organization
Organization Name:ATLANTA MULTI-SPECIALTY ASSOCIATES, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:HECTOR
Authorized Official - Middle Name:H
Authorized Official - Last Name:LOPEZ
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:770-991-2292
Mailing Address - Street 1:6564 PROFESSIONAL PL
Mailing Address - Street 2:SUITE B
Mailing Address - City:RIVERDALE
Mailing Address - State:GA
Mailing Address - Zip Code:30274-2520
Mailing Address - Country:US
Mailing Address - Phone:770-991-2292
Mailing Address - Fax:770-991-2295
Practice Address - Street 1:6564 PROFESSIONAL PL
Practice Address - Street 2:SUITE B
Practice Address - City:RIVERDALE
Practice Address - State:GA
Practice Address - Zip Code:30274-2520
Practice Address - Country:US
Practice Address - Phone:770-991-2292
Practice Address - Fax:770-991-2295
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-28
Last Update Date:2009-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00130908AMedicaid
GA215661640AMedicare ID - Type Unspecified
GAD40484Medicare UPIN