Provider Demographics
NPI:1427453398
Name:AMERICAN PROFESSIONAL ASSOCIATES, LLC
Entity type:Organization
Organization Name:AMERICAN PROFESSIONAL ASSOCIATES, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:MARILYN
Authorized Official - Middle Name:GRACE
Authorized Official - Last Name:DALESSANDRO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-255-7423
Mailing Address - Street 1:75 REMITTANCE DR
Mailing Address - Street 2:SUITE 6653
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60675-6653
Mailing Address - Country:US
Mailing Address - Phone:770-255-7423
Mailing Address - Fax:770-350-6637
Practice Address - Street 1:165 VANN ST NE
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30060-7249
Practice Address - Country:US
Practice Address - Phone:770-422-9856
Practice Address - Fax:770-984-0303
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-04
Last Update Date:2014-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA000471213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Multi-Specialty