| Organization Name: | BAPTIST GROUP OF BUCKHEAD |
| NPI Number: | 1922128875 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | JAVIER A LOPEZ CISNEROS (ADMINISTRATOR) |
| Mailing Address: | 5456 Peachtree Industrial Blvd Suite 305 Atlanta |
| State: | GA US |
| Postal Code: | 303412235 |
| Phone Number: | 4047358641 |
| Fax Number: | 4048981809 |
| NPI Enumeration Date: | 03/31/2007 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 208D00000X |
| License Number: | 150425LGB |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | GA |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | General Practice |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |