Basic Information
| Provider Information | |||||||||
| NPI: | 1134288095 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | AID ATLANTA INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6255 W SUNSET BLVD FL 21 | ||||||||
| Address2: | |||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900287422 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3238605200 | ||||||||
| FaxNumber: | 8332417615 | ||||||||
| Practice Location | |||||||||
| Address1: | 1605 PEACHTREE ST NE | ||||||||
| Address2: | |||||||||
| City: | ATLANTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 303092433 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4048707700 | ||||||||
| FaxNumber: | 4048707719 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/07/2006 | ||||||||
| LastUpdateDate: | 09/11/2019 | ||||||||
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| AuthorizedOfficialLastName: | STIDHAM | ||||||||
| AuthorizedOfficialFirstName: | DONNA | ||||||||
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| AuthorizedOfficialTitleorPosition: | CHIEF OF MANAGED CARE | ||||||||
| AuthorizedOfficialTelephone: | 3238605200 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 291U00000X | 11D1013395 | GA | Y | Laboratories | Clinical Medical Laboratory |
No ID Information.