Provider Demographics
NPI:1699966333
Name:ATLANTA HEALTH & MEDICAL CENTER INC
Entity type:Organization
Organization Name:ATLANTA HEALTH & MEDICAL CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:RAMIREZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:404-875-9919
Mailing Address - Street 1:3283 CHIPPING WOOD CT
Mailing Address - Street 2:
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30004-4304
Mailing Address - Country:US
Mailing Address - Phone:404-875-9919
Mailing Address - Fax:770-442-3210
Practice Address - Street 1:1016 PIEDMONT AVE NE
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30309-3702
Practice Address - Country:US
Practice Address - Phone:404-875-9919
Practice Address - Fax:770-442-3210
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-07
Last Update Date:2007-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA000093133V00000X
GA033179207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAGRP6048OtherGROUP PRACTICE/ CLINIC
GAGRP6048OtherMEDICARE GROUP
GA300032108BMedicaid
GA300032108BMedicaid