Provider Demographics
NPI:1356382865
Name:ATLANTA COLON AND RECTAL SURGERY, PA
Entity type:Organization
Organization Name:ATLANTA COLON AND RECTAL SURGERY, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CORPORATE SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:SANDER
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:BINDEROW
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:404-252-5669
Mailing Address - Street 1:5667 PEACHTREE DUNWOODY RD NE
Mailing Address - Street 2:SUITE 330
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30342-1725
Mailing Address - Country:US
Mailing Address - Phone:404-252-5669
Mailing Address - Fax:404-252-9473
Practice Address - Street 1:5667 PEACHTREE DUNWOODY RD NE
Practice Address - Street 2:SUITE 330
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30342-1725
Practice Address - Country:US
Practice Address - Phone:404-252-5669
Practice Address - Fax:404-252-9473
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-08
Last Update Date:2007-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAGRP1704Medicare PIN