Basic Information
| Provider Information | |||||||||
| NPI: | 1316146483 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ATL COLORECTAL SURGERY | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2221 PEACHTREE RD NE | ||||||||
| Address2: | SUITE D442 | ||||||||
| City: | ATLANTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 303091148 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4045745820 | ||||||||
| FaxNumber: | 6197896513 | ||||||||
| Practice Location | |||||||||
| Address1: | 95 COLLIER RD NW | ||||||||
| Address2: | SUITE 4025 | ||||||||
| City: | ATLANTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 303091796 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4045745820 | ||||||||
| FaxNumber: | 4045745821 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/17/2007 | ||||||||
| LastUpdateDate: | 05/27/2008 | ||||||||
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| AuthorizedOfficialLastName: | HUM | ||||||||
| AuthorizedOfficialFirstName: | MONICA | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRES | ||||||||
| AuthorizedOfficialTelephone: | 4045745820 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | M. D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208C00000X | 53247 | GA | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Colon & Rectal Surgery |
No ID Information.