Provider Demographics
NPI:1740506427
Name:PERSONALIZED PRIMARY CARE OF ATLANTA LLC
Entity type:Organization
Organization Name:PERSONALIZED PRIMARY CARE OF ATLANTA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JULIET
Authorized Official - Middle Name:K
Authorized Official - Last Name:MAVROMATIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:404-583-0978
Mailing Address - Street 1:57 EXECUTIVE PARK S STE 390
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30329-2255
Mailing Address - Country:US
Mailing Address - Phone:404-997-6790
Mailing Address - Fax:404-997-6791
Practice Address - Street 1:57 EXECUTIVE PARK S
Practice Address - Street 2:STE 390
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30329-2288
Practice Address - Country:US
Practice Address - Phone:404-371-1033
Practice Address - Fax:404-997-6790
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-20
Last Update Date:2022-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA043699207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty