Provider Demographics
NPI:1922823863
Name:ATLAS INITIATIVE
Entity type:Organization
Organization Name:ATLAS INITIATIVE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/LEAD DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:
Authorized Official - Last Name:PETERSON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:770-592-2505
Mailing Address - Street 1:2307 STANTON PLACE LN
Mailing Address - Street 2:
Mailing Address - City:ACWORTH
Mailing Address - State:GA
Mailing Address - Zip Code:30101-8894
Mailing Address - Country:US
Mailing Address - Phone:402-450-8664
Mailing Address - Fax:
Practice Address - Street 1:2453 TOWNE LAKE PKWY STE A
Practice Address - Street 2:
Practice Address - City:WOODSTOCK
Practice Address - State:GA
Practice Address - Zip Code:30189-5525
Practice Address - Country:US
Practice Address - Phone:770-592-2505
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-11-16
Last Update Date:2024-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service