Provider Demographics
NPI:1053768309
Name:COMPLETE LASER CLINIC OF ATLANTA
Entity type:Organization
Organization Name:COMPLETE LASER CLINIC OF ATLANTA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANISHUA
Authorized Official - Middle Name:M
Authorized Official - Last Name:ROBERTS
Authorized Official - Suffix:
Authorized Official - Credentials:CPC
Authorized Official - Phone:678-515-4607
Mailing Address - Street 1:4751 BEST RD
Mailing Address - Street 2:SUITE 400Q
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30337-5615
Mailing Address - Country:US
Mailing Address - Phone:678-515-4607
Mailing Address - Fax:470-355-8524
Practice Address - Street 1:4751 BEST RD
Practice Address - Street 2:SUITE 400Q
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30337-5615
Practice Address - Country:US
Practice Address - Phone:678-515-4607
Practice Address - Fax:470-355-8524
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-17
Last Update Date:2016-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive SurgeryGroup - Multi-Specialty