Provider Demographics
NPI:1316146483
Name:ATL COLORECTAL SURGERY
Entity type:Organization
Organization Name:ATL COLORECTAL SURGERY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRES
Authorized Official - Prefix:
Authorized Official - First Name:MONICA
Authorized Official - Middle Name:
Authorized Official - Last Name:HUM
Authorized Official - Suffix:
Authorized Official - Credentials:M D
Authorized Official - Phone:404-574-5820
Mailing Address - Street 1:2221 PEACHTREE RD NE
Mailing Address - Street 2:SUITE D442
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30309-1148
Mailing Address - Country:US
Mailing Address - Phone:404-574-5820
Mailing Address - Fax:619-789-6513
Practice Address - Street 1:95 COLLIER RD NW
Practice Address - Street 2:SUITE 4025
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30309-1796
Practice Address - Country:US
Practice Address - Phone:404-574-5820
Practice Address - Fax:404-574-5821
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-17
Last Update Date:2008-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA53247208C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAH86583Medicare UPIN
GA28BBBDMMedicare PIN