Provider Demographics
NPI:1932924289
Name:ATOC PROFESSIONAL SERVICES
Entity type:Organization
Organization Name:ATOC PROFESSIONAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:WANYAH
Authorized Official - Middle Name:
Authorized Official - Last Name:MAYFIELD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:216-223-8723
Mailing Address - Street 1:6005 FLEET AVENUE
Mailing Address - Street 2:SUITE 102
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44105-3407
Mailing Address - Country:US
Mailing Address - Phone:216-223-8723
Mailing Address - Fax:844-325-0445
Practice Address - Street 1:6005 FLEET AVENUE
Practice Address - Street 2:SUITE 102
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44105-3407
Practice Address - Country:US
Practice Address - Phone:216-223-8723
Practice Address - Fax:844-325-0445
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-11-21
Last Update Date:2024-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center