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Specialty details in registry · Atlanta, GA

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At a glance

5829 Campbellton Rd Sw Ste 104-122, Atlanta, GA 30331-8037

NPPES record updated Nov 17, 2025. Public records can lag behind changes at a practice.

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Practice location

5829 Campbellton Rd Sw Ste 104-122
Atlanta, GA 30331-8037

Professional details: NPI, taxonomy & registry record

NPI1194685552

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Registry details

Primary taxonomy: Specialty details in registry
Taxonomy code: 3747P1801X
Enumeration date: Nov 17, 2025
Record updated: Nov 17, 2025

More registry details

Provider type: Organization · Type 2

Reported taxonomies and licenses

Specialty details in registry

3747P1801X · Primary

License numbers and credentials are reported to NPPES; HCPList does not independently verify them.

Practice location

5829 Campbellton Rd Sw Ste 104-122
Atlanta, GA 30331-8037

Phone: (470) 917-6976

Mailing address

5829 CAMPBELLTON RD SW STE 104-122

ATLANTA, GA 303318037

Source: NPPES Source through Oct 18, 2026An NPI does not verify licensure or credentials.

Information may be outdated or incomplete. Confirm details directly with the practice. HCPList is an independent directory and is not affiliated with CMS.

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