Provider Demographics
NPI:1720784234
Name:CLINICA MATERNIDAD DE ATLANTA LLC
Entity type:Organization
Organization Name:CLINICA MATERNIDAD DE ATLANTA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SANTIAGO
Authorized Official - Middle Name:A
Authorized Official - Last Name:TORRES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-809-2006
Mailing Address - Street 1:3652 CHAMBLEE DUNWOODY RD STE 2
Mailing Address - Street 2:
Mailing Address - City:CHAMBLEE
Mailing Address - State:GA
Mailing Address - Zip Code:30341-2120
Mailing Address - Country:US
Mailing Address - Phone:404-809-2006
Mailing Address - Fax:404-737-8236
Practice Address - Street 1:3652 CHAMBLEE DUNWOODY RD STE 2
Practice Address - Street 2:
Practice Address - City:CHAMBLEE
Practice Address - State:GA
Practice Address - Zip Code:30341-2120
Practice Address - Country:US
Practice Address - Phone:404-809-2006
Practice Address - Fax:404-737-8236
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-06
Last Update Date:2023-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Multi-Specialty