Provider Demographics
NPI:1215069166
Name:ATLAS SURGERY CENTER OF BUCKHEAD, INC
Entity type:Organization
Organization Name:ATLAS SURGERY CENTER OF BUCKHEAD, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:BASILLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-701-2225
Mailing Address - Street 1:PO BOX 673363
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30006-0057
Mailing Address - Country:US
Mailing Address - Phone:678-701-2225
Mailing Address - Fax:678-412-1672
Practice Address - Street 1:2045 PEACHTREE RD NE STE T1
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30309-1405
Practice Address - Country:US
Practice Address - Phone:786-701-2225
Practice Address - Fax:678-412-1672
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-09
Last Update Date:2021-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA060-096261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical