Provider Demographics
NPI:1003174624
Name:ATLANTA INTERNAL MEDICINE AND PSYCHIATRIC CARE
Entity type:Organization
Organization Name:ATLANTA INTERNAL MEDICINE AND PSYCHIATRIC CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:C
Authorized Official - Last Name:LUNCEFORD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:770-396-0232
Mailing Address - Street 1:3915 CASCADE RD SW STE 360
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30331-8533
Mailing Address - Country:US
Mailing Address - Phone:770-317-7300
Mailing Address - Fax:470-819-4995
Practice Address - Street 1:3915 CASCADE RD SW STE 360
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30331-8533
Practice Address - Country:US
Practice Address - Phone:678-973-2370
Practice Address - Fax:470-819-4995
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-02
Last Update Date:2024-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003125640AMedicaid
GAREF000549852Medicaid