Organization
INFECTIOUS DISEASE GROUP OF ATLANTA, LLC
Active
Other names
ID Group of Atlanta, LLC
Organization subpart
No
Provider details
NPI number
Authorized official
JOHN P OUDERKIRK M.D. (OWNER)
(404) 588-4680
Entity
Organization
Contact information
Practice address
735 PIEDMONT AVE NE, ATLANTA, GA 30308-1416
(404) 588-4680
(404) 588-4692
Mailing address
735 PIEDMONT AVE NE, ATLANTA, GA 30308-1416
(404) 588-4680
(404) 588-4692
Taxonomy
Speciality
Code
Description
License number
State
207RI0200X
Infectious Disease Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
055003616A
—
GA
01
—
11D1023598
CLIA IDENTIFICATION #
—
Enumeration date
11/07/2006
Last updated
07/06/2012
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