Organization Name: | FAMILY MEDICAL & URGENT CARE CENTER OF MCDONOUGH, LLC |
NPI Number: | 1043440530 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | ALLAN B IMES (MANAGING PHYSIOCIAN ASSISTANT) |
Mailing Address: | 1631 Hwy 20 W Mcdonough |
State: | GA US |
Postal Code: | 302537311 |
Phone Number: | 7702882822 |
Fax Number: | 7702882820 |
NPI Enumeration Date: | 07/20/2009 |
NPI Last Update Date: | 08/04/2009 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363AM0700X |
License Number: | 004088 |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | GA |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Physician Assistant |
Taxonomy Specialization: | Medical |
Taxonomy Definition: |