Provider Demographics
NPI:1053403857
Name:ATLANTA PRIMARY CARE CENTER, P.C.
Entity type:Organization
Organization Name:ATLANTA PRIMARY CARE CENTER, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:DELPHANIE
Authorized Official - Middle Name:DESHAN
Authorized Official - Last Name:HEAD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:404-524-8950
Mailing Address - Street 1:285 BOULEVARD NE
Mailing Address - Street 2:SUITE 435
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30312-4205
Mailing Address - Country:US
Mailing Address - Phone:404-524-8950
Mailing Address - Fax:404-524-8948
Practice Address - Street 1:285 BOULEVARD NE
Practice Address - Street 2:SUITE 435
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30312-4205
Practice Address - Country:US
Practice Address - Phone:404-524-8950
Practice Address - Fax:404-524-8948
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-29
Last Update Date:2007-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAGRP5058Medicare PIN