Provider Demographics
NPI:1487959110
Name:ATLAS MEDICAL GROUP, PA
Entity type:Organization
Organization Name:ATLAS MEDICAL GROUP, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:LORENZO
Authorized Official - Last Name:ATLAS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:714-396-7105
Mailing Address - Street 1:701 E ROOSEVELT BLVD
Mailing Address - Street 2:SUITE 320
Mailing Address - City:MONROE
Mailing Address - State:NC
Mailing Address - Zip Code:28112-5170
Mailing Address - Country:US
Mailing Address - Phone:714-396-7105
Mailing Address - Fax:
Practice Address - Street 1:701 E ROOSEVELT BLVD
Practice Address - Street 2:SUITE 320
Practice Address - City:MONROE
Practice Address - State:NC
Practice Address - Zip Code:28112-5170
Practice Address - Country:US
Practice Address - Phone:714-396-7105
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-11
Last Update Date:2011-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty