Organization Name: | ADVANCED MEDICAL CLINICS, P.C. |
NPI Number: | 1043495427 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | LISA ROCHE (OFFICE MANAGER) |
Mailing Address: | 5499 Jonesboro Rd Lake City |
State: | GA US |
Postal Code: | 302603553 |
Phone Number: | 4043636460 |
Fax Number: | 4043634348 |
NPI Enumeration Date: | 01/04/2008 |
NPI Last Update Date: | 01/04/2008 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 208D00000X |
License Number: | 047279 |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | GA |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | General Practice |
Taxonomy Specialization: | |
Taxonomy Definition: |