Provider Demographics
NPI:1649497157
Name:AID ATLANTA INC
Entity type:Organization
Organization Name:AID ATLANTA INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:R
Authorized Official - Last Name:RODRIGUEZ-DIAZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD, MPH, MS
Authorized Official - Phone:404-870-7720
Mailing Address - Street 1:1605 PEACHTREE ST NE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30309-2433
Mailing Address - Country:US
Mailing Address - Phone:404-870-7700
Mailing Address - Fax:404-870-7719
Practice Address - Street 1:1605 PEACHTREE ST NE
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30309-2433
Practice Address - Country:US
Practice Address - Phone:404-870-7700
Practice Address - Fax:404-870-7719
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-19
Last Update Date:2014-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000519538AMedicaid