MEDICARE: GEORGETOWN CLINIC

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	208D00000X	General Practice Physician	38981	GA

General Provider Information

NPI Number	:	1558630947
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GEORGETOWN CLINIC

Provider Business Mailing Address
First Line	:	236 JOHNSON FERRY RD NE
Second Line	:	SUITE 200
City	:	ATLANTA
State	:	GA
Zip	:	30328-7402
Country	:	US
Telephone Number	:	404-255-0666
Fax Number	:	404-705-9942

Provider Business Practice Location Address
First Line	:	236 JOHNSON FERRY RD NE
Second Line	:	SUITE 200
City	:	ATLANTA
State	:	GA
Zip	:	30328-7402
Country	:	US
Telephone Number	:	404-255-0666
Fax Number	:	404-705-9942

Authorized Official
Title or Position	:	PRESIDENT
Name	:	RAMIN STEPHAN BAYANI
Credential	:	D.C.
Telephone Number	:	404-255-0666

Provider Enumeration Date	:	12/14/2011
Last Update Date	:	12/23/2011

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