Provider Demographics
NPI:1790430429
Name:ATLANTIC UROLOGY CLINIC LLC
Entity type:Organization
Organization Name:ATLANTIC UROLOGY CLINIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF REVENUE CYCLE
Authorized Official - Prefix:
Authorized Official - First Name:DEBBIE
Authorized Official - Middle Name:L
Authorized Official - Last Name:BOLIG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:843-347-2450
Mailing Address - Street 1:611 BURROUGHS AND CHAPIN BLVD STE 105
Mailing Address - Street 2:
Mailing Address - City:MYRTLE BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29577-3200
Mailing Address - Country:US
Mailing Address - Phone:843-347-2450
Mailing Address - Fax:
Practice Address - Street 1:823 82ND PKWY
Practice Address - Street 2:
Practice Address - City:MYRTLE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29572-4607
Practice Address - Country:US
Practice Address - Phone:843-347-2450
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ATLANTIC UROLOGY CLINIC LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-02-22
Last Update Date:2022-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332900000XSuppliersNon-Pharmacy Dispensing Site