Provider Demographics
NPI:1962696203
Name:ATLANTA SURGERY GROUP SPECIALISTS LLC
Entity type:Organization
Organization Name:ATLANTA SURGERY GROUP SPECIALISTS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MARIO
Authorized Official - Middle Name:
Authorized Official - Last Name:LUQUE
Authorized Official - Suffix:
Authorized Official - Credentials:CSA-FA
Authorized Official - Phone:404-668-6112
Mailing Address - Street 1:PO BOX 11512
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30355-1512
Mailing Address - Country:US
Mailing Address - Phone:404-668-6112
Mailing Address - Fax:
Practice Address - Street 1:4088 JONES BRIDGE CIR
Practice Address - Street 2:
Practice Address - City:NORCROSS
Practice Address - State:GA
Practice Address - Zip Code:30092-1214
Practice Address - Country:US
Practice Address - Phone:404-668-6112
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-29
Last Update Date:2012-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246ZS0410XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical TechnologistGroup - Single Specialty