Provider Demographics
NPI:1669570990
Name:UROLOGY OF GREATER ATLANTA LLC
Entity type:Organization
Organization Name:UROLOGY OF GREATER ATLANTA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:CHERIS
Authorized Official - Middle Name:L
Authorized Official - Last Name:CRAIG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-474-5281
Mailing Address - Street 1:180 N PARK TRL STE 100
Mailing Address - Street 2:
Mailing Address - City:STOCKBRIDGE
Mailing Address - State:GA
Mailing Address - Zip Code:30281-7372
Mailing Address - Country:US
Mailing Address - Phone:770-474-5281
Mailing Address - Fax:770-389-8674
Practice Address - Street 1:180 N PARK TRL STE 100
Practice Address - Street 2:
Practice Address - City:STOCKBRIDGE
Practice Address - State:GA
Practice Address - Zip Code:30281-7372
Practice Address - Country:US
Practice Address - Phone:770-474-5281
Practice Address - Fax:770-389-8674
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2024-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAGRP6913Medicare ID - Type UnspecifiedGROUP ID NUMBER