Provider Demographics
NPI:1366547580
Name:NORTH FULTON UROLOGY PC
Entity type:Organization
Organization Name:NORTH FULTON UROLOGY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JUDY
Authorized Official - Middle Name:R
Authorized Official - Last Name:BRUNI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-475-7550
Mailing Address - Street 1:1357 HEMBREE RD
Mailing Address - Street 2:SUITE 250
Mailing Address - City:ROSWELL
Mailing Address - State:GA
Mailing Address - Zip Code:30076-5722
Mailing Address - Country:US
Mailing Address - Phone:770-475-7550
Mailing Address - Fax:770-343-9080
Practice Address - Street 1:1357 HEMBREE ROAD
Practice Address - Street 2:SUITE 250
Practice Address - City:ROSWELL
Practice Address - State:GA
Practice Address - Zip Code:30076
Practice Address - Country:US
Practice Address - Phone:770-475-7550
Practice Address - Fax:770-343-9080
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-13
Last Update Date:2008-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GACL8520OtherRRMCARE
GAGRP51Medicare PIN