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NPI Code Detail

MEDICARE: CLINICA UNION

MEDICARE: CLINICA UNION
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
1207Q00000XFamily Medicine Physician

General Provider Information

NPI Number : 1588030886
Entity Type Code : Organization
Provider Name (Legal Business Name) : CLINICA UNION
Provider Business Mailing Address
First Line : 3369 BUFORD HWY NE
Second Line : SUITE 810
City : BROOKHAVEN
State : GA
Zip : 30329-3722
Country : US
Telephone Number : 404-321-4692
Fax Number :
Provider Business Practice Location Address
First Line : 5151 BROOK HOLLOW PKWY
Second Line : STE 145
City : NORCROSS
State : GA
Zip : 30071-3664
Country : US
Telephone Number : 404-321-4692
Fax Number :
Authorized Official
Title or Position : CEO
Name : MARIO RIVERA
Credential :
Telephone Number : 404-321-4692
Provider Enumeration Date : 08/20/2015
Last Update Date : 08/20/2015

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Directions to “CLINICA UNION ” Practice Location

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