Provider Demographics
NPI:1457130759
Name:ATLANTA MEDICAL CLINIC OF MIDTOWN LLC
Entity Type:Organization
Organization Name:ATLANTA MEDICAL CLINIC OF MIDTOWN LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:J
Authorized Official - Last Name:DEMBOWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-872-8837
Mailing Address - Street 1:197 14TH ST NW STE 300B
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30318-7815
Mailing Address - Country:US
Mailing Address - Phone:404-872-8837
Mailing Address - Fax:
Practice Address - Street 1:197 14TH ST NW STE 300B
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30318-7815
Practice Address - Country:US
Practice Address - Phone:404-872-8837
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-26
Last Update Date:2023-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty