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SOUTH ATLANTA PRIMARY CARE PC NPI 1710183454


NPI Information

NPI: 1710183454
Provider Name: SOUTH ATLANTA PRIMARY CARE PC
Classification: Legal Medicine - 173000000X
Entity Type: Organization
Address:
6568A TARA BLVD
JONESBORO, GA
ZIP 30236
Phone: (770) 968-7933
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SOUTH ATLANTA PRIMARY CARE PC is a legal medicine in Jonesboro, GA. The provider is the specialty areas of medicine concerned with matters of, and relations with, substantive law and legal institutions; such as the conduct of medical examinations at crime scenes, performance of autopsies, giving of expert medical testimony in judicial proceedings, medical treatment of inmates of penal institutions, the practice of trauma medicine in law enforcement settings, and other clinical practice and medical science applications in the fields of law, law enforcement, and corrections. SOUTH ATLANTA PRIMARY CARE PC NPI is 1710183454. The provider is registered as an organization entity type and is a single specialty group.

The provider's business location address is:

6568A TARA BLVD
JONESBORO, GA
ZIP 30236-228
Phone: (770) 968-7933
Fax: (770) 968-6521

The provider's authorized official is Michael Angel Dicristina .
The authorized official title is Physician Owner and has the following contact phone number (770) 968-7933.

The enumeration date for this NPI number is 6/21/2007 and was last updated on 8/22/2020.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1173000000XLegal Medicine022223GEORGIAYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
11144226135OTHERGEORGIAIND NPI NUMBER

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

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