Provider Demographics
NPI:1487780599
Name:RHEUMATOLOGY OF NORTH ATLANTA
Entity type:Organization
Organization Name:RHEUMATOLOGY OF NORTH ATLANTA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ROEL
Authorized Official - Middle Name:NOLIDO
Authorized Official - Last Name:QUERUBIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:678-226-2600
Mailing Address - Street 1:PO BOX 942449
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:31141-2449
Mailing Address - Country:US
Mailing Address - Phone:678-226-2600
Mailing Address - Fax:678-226-2635
Practice Address - Street 1:4790 SUGARLOAF PKWY
Practice Address - Street 2:SUITE 100
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30044-6985
Practice Address - Country:US
Practice Address - Phone:678-226-2600
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA043112207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA66BBBGTMedicare ID - Type UnspecifiedCARRIER PROVIDER NUMBER
GAGRP6671Medicare ID - Type UnspecifiedMEDICARE NUMBER
GAI15638Medicare UPIN