Provider Demographics
NPI:1730345687
Name:ATLAS MANAGEMENT CARE
Entity type:Organization
Organization Name:ATLAS MANAGEMENT CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MEKUS
Authorized Official - Middle Name:E
Authorized Official - Last Name:MBANUZI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-375-3966
Mailing Address - Street 1:2315 CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28205-5207
Mailing Address - Country:US
Mailing Address - Phone:704-375-3966
Mailing Address - Fax:704-375-3964
Practice Address - Street 1:2315 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28205-5207
Practice Address - Country:US
Practice Address - Phone:704-375-3966
Practice Address - Fax:704-375-3964
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-31
Last Update Date:2008-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC302R00000X302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization