Provider Demographics
NPI:1396290680
Name:ATLANTA HEALTH SYSTEM CORP
Entity type:Organization
Organization Name:ATLANTA HEALTH SYSTEM CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RAMON
Authorized Official - Middle Name:
Authorized Official - Last Name:ABREU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-934-5181
Mailing Address - Street 1:3348 PEACHTREE RD NE STE 700
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30326-1442
Mailing Address - Country:US
Mailing Address - Phone:404-934-5181
Mailing Address - Fax:470-200-0254
Practice Address - Street 1:3348 PEACHTREE RD NE STE 700
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30326-1442
Practice Address - Country:US
Practice Address - Phone:404-934-5181
Practice Address - Fax:470-200-0254
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-17
Last Update Date:2016-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center