MEDICARE: BUCKHEAD CONCIERGE INTERNAL MEDICINE, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	059636	GA

General Provider Information

NPI Number	:	1245400514
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BUCKHEAD CONCIERGE INTERNAL MEDICINE, LLC

Provider Business Mailing Address
First Line	:	91 W WIEUCA RD NE
Second Line	:	SUITE 1000
City	:	ATLANTA
State	:	GA
Zip	:	30342-3248
Country	:	US
Telephone Number	:	404-257-5585
Fax Number	:

Provider Business Practice Location Address
First Line	:	91 W WIEUCA RD NE
Second Line	:	SUITE 1000
City	:	ATLANTA
State	:	GA
Zip	:	30342-3248
Country	:	US
Telephone Number	:	404-257-5585
Fax Number	:	404-257-9985

Authorized Official
Title or Position	:	PHYSICIAN OWNER
Name	:	EDWARD ANTONIO ESPINOSA
Credential	:	MD
Telephone Number	:	404-257-5585

Provider Enumeration Date	:	03/03/2008
Last Update Date	:	03/06/2018

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