Provider Demographics
NPI:1205905833
Name:ATLANTIC CARE ASSOCIATES PC
Entity type:Organization
Organization Name:ATLANTIC CARE ASSOCIATES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ALESIA
Authorized Official - Middle Name:W
Authorized Official - Last Name:GRIFFIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:757-366-0692
Mailing Address - Street 1:PO BOX 13129
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23325-0129
Mailing Address - Country:US
Mailing Address - Phone:757-366-0692
Mailing Address - Fax:757-366-9118
Practice Address - Street 1:2147 OLD GREENBRIER RD
Practice Address - Street 2:SUITE A
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23320-2635
Practice Address - Country:US
Practice Address - Phone:757-366-0692
Practice Address - Fax:757-366-9118
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101227850207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
H37579Medicare UPIN