Basic Information
| Provider Information | |||||||||
| NPI: | 1598194805 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | METRO ATLANTA DIAGNOSTICS LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4535 WINTERS CHAPEL RD | ||||||||
| Address2: | |||||||||
| City: | ATLANTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 303602705 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7702857246 | ||||||||
| FaxNumber: | 7709990809 | ||||||||
| Practice Location | |||||||||
| Address1: | 4535 WINTERS CHAPEL RD | ||||||||
| Address2: | |||||||||
| City: | ATLANTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 303602705 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7702857246 | ||||||||
| FaxNumber: | 7709990809 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/06/2013 | ||||||||
| LastUpdateDate: | 12/12/2019 | ||||||||
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| AuthorizedOfficialLastName: | DUNN | ||||||||
| AuthorizedOfficialFirstName: | MATTHEW | ||||||||
| AuthorizedOfficialMiddleName: | J | ||||||||
| AuthorizedOfficialTitleorPosition: | MEMBER | ||||||||
| AuthorizedOfficialTelephone: | 7702857246 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | DC | ||||||||
| NPICertificationDate: | 12/12/2019 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.