Provider Demographics
NPI:1982818951
Name:METRO ATLANTA ACCESS CENTER LLC
Entity Type:Organization
Organization Name:METRO ATLANTA ACCESS CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT - CHAIRMAN OF THE BOARD
Authorized Official - Prefix:
Authorized Official - First Name:ANGUS
Authorized Official - Middle Name:C
Authorized Official - Last Name:HOWARD
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:404-696-7300
Mailing Address - Street 1:3885 PRINCETON LAKES WAY SW
Mailing Address - Street 2:SUITE 314
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30331-5589
Mailing Address - Country:US
Mailing Address - Phone:404-349-7770
Mailing Address - Fax:404-349-7778
Practice Address - Street 1:3885 PRINCETON LAKES WAY SW
Practice Address - Street 2:SUITE 314
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30331-5589
Practice Address - Country:US
Practice Address - Phone:404-349-7770
Practice Address - Fax:404-349-7778
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-09
Last Update Date:2011-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Multi-Specialty
No174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA1598755993OtherNPI
GA1730127945OtherNPI
GA221585150AMedicaid
GA1649345919OtherNPI
GRP8104Medicare PIN