Provider Demographics
NPI:1871741389
Name:GEORGIA MUA, LLC
Entity type:Organization
Organization Name:GEORGIA MUA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:404-788-6140
Mailing Address - Street 1:1276 MCCONNELL DR
Mailing Address - Street 2:STE. A&B
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30033-3508
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1276 MCCONNELL DR
Practice Address - Street 2:STE. A&B
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30033-3508
Practice Address - Country:US
Practice Address - Phone:404-348-4348
Practice Address - Fax:877-451-8595
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-09
Last Update Date:2008-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA008268111N00000X
GA041961208VP0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain MedicineGroup - Multi-Specialty
No111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty