Organization Name: | BONSERVA ACUTE PRIMARY CARE CENTER |
NPI Number: | 1295966216 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | CAMILLE PLESHETTE COOK (FAMILY NURSE PRACTITIONER) |
Mailing Address: | 4940 Governors Dr Ste 209 Forest Park |
State: | GA US |
Postal Code: | 302972186 |
Phone Number: | 4043668111 |
Fax Number: | 4043668102 |
NPI Enumeration Date: | 08/07/2009 |
NPI Last Update Date: | 08/07/2009 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 261QP2300X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Ambulatory Health Care Facilities |
Taxonomy Classification: | Clinic/Center |
Taxonomy Specialization: | Primary Care |
Taxonomy Definition: |