Organization
UROLOGY SPECIALISTS OF ATLANTA, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. BRUCE GARY GREEN MD (PRESIDENT)
(404) 255-3822
Entity
Organization
Contact information
Practice address
5673 PEACHTREE DUNWOODY RD NE, SUITE 910, ATLANTA, GA 30342-1731
(404) 255-3822
(404) 255-0495
Mailing address
5673 PEACHTREE DUNWOODY RD NE, SUITE 910, ATLANTA, GA 30342-1731
(404) 255-3822
(404) 255-0495
Taxonomy
Speciality
Code
Description
License number
State
208800000X
Urology Physician
BL02-00533
GA
208800000X
Urology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
GRP7474
MEDICARE PTAN
GA
Enumeration date
08/06/2006
Last updated
11/17/2010
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