| Organization Name: | WATERFORD MEDICAL CLINIC |
| NPI Number: | 1366712846 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | JOHN SALINAS (MEDICAL DIRECTOR) |
| Mailing Address: | 3069 Amwiler Rd Suite Two Atlanta |
| State: | GA US |
| Postal Code: | 303602825 |
| Phone Number: | 6789699920 |
| Fax Number: | 6789699919 |
| NPI Enumeration Date: | 12/30/2011 |
| NPI Last Update Date: | 12/30/2011 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 208D00000X |
| License Number: | 038600 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | GA |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | General Practice |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |