Provider Demographics
NPI:1154436921
Name:ATLANTA MEDICAL CARE
Entity type:Organization
Organization Name:ATLANTA MEDICAL CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:CHUKWUDI
Authorized Official - Middle Name:BATO
Authorized Official - Last Name:AMU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:404-766-6001
Mailing Address - Street 1:5526 OLD NATIONAL HWY
Mailing Address - Street 2:BLDG. J
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30349-3249
Mailing Address - Country:US
Mailing Address - Phone:404-766-6001
Mailing Address - Fax:678-904-2769
Practice Address - Street 1:5526 OLD NATIONAL HWY
Practice Address - Street 2:BLDG. J
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30349-3249
Practice Address - Country:US
Practice Address - Phone:404-766-6001
Practice Address - Fax:678-904-2769
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA026967207Q00000X
GA54376207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Not Answered207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA11BDDHNMedicare ID - Type UnspecifiedDR. AMU'S MEDICARE #