Basic Information
| Provider Information | |||||||||
| NPI: | 1629408257 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ATLANTIS MULTISPECIALTY GROUP AZ PLLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 14367 | ||||||||
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| City: | SCOTTSDALE | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 852674367 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3184244008 | ||||||||
| FaxNumber: | 3184246606 | ||||||||
| Practice Location | |||||||||
| Address1: | 2155 E CONFERENCE DR | ||||||||
| Address2: | |||||||||
| City: | TEMPE | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 852842604 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6024328813 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/18/2013 | ||||||||
| LastUpdateDate: | 01/31/2014 | ||||||||
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| AuthorizedOfficialLastName: | TOWNS | ||||||||
| AuthorizedOfficialFirstName: | DAVID | ||||||||
| AuthorizedOfficialMiddleName: | K | ||||||||
| AuthorizedOfficialTitleorPosition: | MANAGING DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 6024328813 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Anesthesiology |
No ID Information.