Provider Demographics
NPI:1316144058
Name:AEROCLINIC
Entity type:Organization
Organization Name:AEROCLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE VICE PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROSEMARY
Authorized Official - Middle Name:M
Authorized Official - Last Name:KELLY
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:770-996-2630
Mailing Address - Street 1:1745 PHOENIX BLVD
Mailing Address - Street 2:SUITE 340
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30349-5591
Mailing Address - Country:US
Mailing Address - Phone:770-996-2630
Mailing Address - Fax:
Practice Address - Street 1:6000 NORTH TERMINAL PARKWAY
Practice Address - Street 2:SUITE 375, ATRIUM ATLANTA HARTSFIELD-JACKSON AIRPORT
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30320-7400
Practice Address - Country:US
Practice Address - Phone:404-616-6000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-27
Last Update Date:2010-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA031630207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty