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186 Sunset Ave Nw Atlanta GA 30314-4059 | |
| (404) 613-5456 | |
| (404) 224-5230 |
| Full Name | |
|---|---|
| Speciality | Clinic/center - Federally Qualified Health Center (fqhc) |
| Location | 186 Sunset Ave Nw, Atlanta, Georgia |
| Authorized Official Name and Position | Michael W Brooks (PRESIDENT, CEO) |
| Authorized Official Contact | 4047521400 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
868 York Ave Sw Atlanta GA 30310-2750 Ph: (404) 752-1400 | 186 Sunset Ave Nw Atlanta GA 30314-4059 Ph: (404) 613-5456 |
| NPI Number | 1770843864 |
|---|---|
| Provider Enumeration Date | 05/22/2012 |
| Last Update Date | 02/10/2014 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1770843864 | NPI | - | NPPES |
| 003124263A | Medicaid | GA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |
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