Provider Demographics
NPI:1386054088
Name:PHYSICIANS CARE CENTER OF ATLANTA
Entity type:Organization
Organization Name:PHYSICIANS CARE CENTER OF ATLANTA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:NEIL
Authorized Official - Middle Name:
Authorized Official - Last Name:REICH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:727-409-3498
Mailing Address - Street 1:315 BOULEVARD NE STE 200
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30312-1220
Mailing Address - Country:US
Mailing Address - Phone:404-222-9914
Mailing Address - Fax:
Practice Address - Street 1:315 BOULEVARD NE STE 200
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30312-1220
Practice Address - Country:US
Practice Address - Phone:404-222-9914
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-02
Last Update Date:2014-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332900000XSuppliersNon-Pharmacy Dispensing Site