Healthcare Provider Details

I. General information

NPI: 1285178582
Provider Name (Legal Business Name): ATLANTIC FAMILY MEDICAL CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/06/2016
Last Update Date: 12/06/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7219 ATLANTIC AVE
BELL CA
90201-4302
US

IV. Provider business mailing address

7219 ATLANTIC AVE
BELL CA
90201-4302
US

V. Phone/Fax

Practice location:
  • Phone: 323-553-9333
  • Fax:
Mailing address:
  • Phone: 323-553-9333
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License NumberA67059
License Number StateCA

VIII. Authorized Official

Name: DR. BRIAN PAYNE
Title or Position: CEO
Credential: MD
Phone: 323-553-9333