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Organization
PSL ATCA LLC
Active
Organization
PSL ATCA LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. GREGORY BUCKLEY MBA (CEO)
(404) 290-1029
Entity
Organization
Contact information
Practice address
266 NW PEACOCK BLVD STE 204, PORT ST. LUCIE, FL 34986-2271
(404) 290-1029
Mailing address
890 RIVERHAVEN DR, SUWANEE, GA 30024-4238
(404) 290-1029
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
—
—
207R00000X
Internal Medicine Physician
Primary
—
—
261QM1300X
Multi-Specialty Clinic/Center
—
—
Other
Enumeration date
12/10/2024
Last updated
12/10/2024
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