1275816472 NPI number — SURGICAL & BARIATRIC ASSOCIATES OF ATLANTA MEDICAL CENTER, LLC

Table of content: (NPI 1275816472)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1275816472 NPI number — SURGICAL & BARIATRIC ASSOCIATES OF ATLANTA MEDICAL CENTER, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SURGICAL & BARIATRIC ASSOCIATES OF ATLANTA MEDICAL CENTER, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1275816472
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/23/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 741863
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ATLANTA
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30374-1863
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
404-881-8020
Provider Business Mailing Address Fax Number:
678-553-3179

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
285 BOULEVARD NE
Provider Second Line Business Practice Location Address:
SUITE 120
Provider Business Practice Location Address City Name:
ATLANTA
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30312-4205
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
404-881-8020
Provider Business Practice Location Address Fax Number:
678-553-3179
Provider Enumeration Date:
09/23/2011

Additional Information

Authorized Official

Authorized Official Last Name:
USE MICHAEL 'KYLE' K. BURTNETT; SVP
Authorized Official First Name:
MICHAEL
Authorized Official Middle Name:
KYLE
Authorized Official Title or Position:
SVP OF OUTPATIENT SERVICES, TENET
Authorized Official Telephone Number:
469-893-2153

Provider Taxonomy Codes

  • Taxonomy code: 208600000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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