Provider Demographics
NPI:1316695992
Name:CAPITAL CITY MD, LLC
Entity type:Organization
Organization Name:CAPITAL CITY MD, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING SUPERVISOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:
Authorized Official - Last Name:BRODIE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-267-5566
Mailing Address - Street 1:3286 BUCKEYE RD
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30341-4228
Mailing Address - Country:US
Mailing Address - Phone:404-267-5566
Mailing Address - Fax:404-267-5565
Practice Address - Street 1:5700 HILLANDALE DR STE 150A
Practice Address - Street 2:
Practice Address - City:LITHONIA
Practice Address - State:GA
Practice Address - Zip Code:30058-4120
Practice Address - Country:US
Practice Address - Phone:404-267-5566
Practice Address - Fax:404-267-5565
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-14
Last Update Date:2022-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Multi-Specialty