Provider Demographics
NPI:1770968943
Name:ATLANTIC MEDICAL GROUP
Entity type:Organization
Organization Name:ATLANTIC MEDICAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:VICTORIA
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:330-456-3487
Mailing Address - Street 1:3501 LESH ST NE
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44705-4376
Mailing Address - Country:US
Mailing Address - Phone:330-456-3487
Mailing Address - Fax:330-456-3895
Practice Address - Street 1:2223 FULTON RD NW STE 102
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44709-3554
Practice Address - Country:US
Practice Address - Phone:330-456-3487
Practice Address - Fax:330-456-3895
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-29
Last Update Date:2025-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty