| Organization Name: | EXPRESS MEDICAL, LLC |
| NPI Number: | 1053691311 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | REGINALD WT PHILIP (PRACTICE MANAGER) |
| Mailing Address: | 931 Lower Fayetteville Rd Suite J Newnan |
| State: | GA US |
| Postal Code: | 302635790 |
| Phone Number: | 7707159391 |
| Fax Number: | |
| NPI Enumeration Date: | 08/18/2011 |
| NPI Last Update Date: | 08/25/2011 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QP2300X |
| License Number: | 142462 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | GA |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Primary Care |
| Taxonomy Definition: | |