Provider Demographics
NPI:1831529841
Name:WL MD ATLANTA, LLC
Entity type:Organization
Organization Name:WL MD ATLANTA, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:BOARD MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:DAVE
Authorized Official - Middle Name:
Authorized Official - Last Name:DORIAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-777-7495
Mailing Address - Street 1:9925 HAYNES BRIDGE RD
Mailing Address - Street 2:#320
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30022-8532
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:9925 HAYNES BRIDGE RD
Practice Address - Street 2:#320
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30022-8532
Practice Address - Country:US
Practice Address - Phone:770-777-7495
Practice Address - Fax:770-777-7459
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-13
Last Update Date:2013-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service