Provider Demographics
NPI:1912284480
Name:ATLANTA CENTRAL MEDICAL GROUP, INC.
Entity Type:Organization
Organization Name:ATLANTA CENTRAL MEDICAL GROUP, INC.
Other - Org Name:CENTRAL MEDICAL GROUP
Other - Org Type:Other Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:KUY IK
Authorized Official - Middle Name:
Authorized Official - Last Name:PARK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-467-9882
Mailing Address - Street 1:5360 BEAVER BR
Mailing Address - Street 2:
Mailing Address - City:NORCROSS
Mailing Address - State:GA
Mailing Address - Zip Code:30071-4579
Mailing Address - Country:US
Mailing Address - Phone:678-467-9882
Mailing Address - Fax:
Practice Address - Street 1:2400 PLEASANT HILL RD
Practice Address - Street 2:300
Practice Address - City:DULUTH
Practice Address - State:GA
Practice Address - Zip Code:30096-4396
Practice Address - Country:US
Practice Address - Phone:678-467-9882
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-10
Last Update Date:2011-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain MedicineGroup - Multi-Specialty
No2083P0500XAllopathic & Osteopathic PhysiciansPreventive MedicinePreventive Medicine/Occupational Environmental MedicineGroup - Multi-Specialty