Organization
ID GROUP OF ATLANTA
Active
Organization
ID GROUP OF ATLANTA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JOHN P OUDERKIRK MD (MEMBER)
(404) 588-4680
Entity
Organization
Contact information
Practice address
735 PIEDMONT AVENUE, NE, ATLANTA, GA 30308
(404) 588-4680
Mailing address
735 PIEDMONT AVENUE, NE, ATLANTA, GA 30308
(404) 588-4680
Taxonomy
Speciality
Code
Description
License number
State
332900000X
Non-Pharmacy Dispensing Site
Primary
049992
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000926318A
—
GA
Enumeration date
12/16/2013
Last updated
12/16/2013
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