Healthcare Provider Details

I. General information

NPI: 1770950818
Provider Name (Legal Business Name): FCN MEDICAL GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/24/2015
Last Update Date: 08/24/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

303 PERIMETER CTR N STE. 300
ATLANTA GA
30346-3402
US

IV. Provider business mailing address

303 PERIMETER CTR N STE. 300
ATLANTA GA
30346-3402
US

V. Phone/Fax

Practice location:
  • Phone: 678-534-3477
  • Fax:
Mailing address:
  • Phone: 678-534-3477
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. JOHN JETER
Title or Position: OWNER
Credential:
Phone: 678-534-3477