Healthcare Provider Details

I. General information

NPI: 1285961011
Provider Name (Legal Business Name): ESSENTIAL MEDICAL CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/16/2009
Last Update Date: 12/02/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1897 GODBY ROAD
COLLEGE PARK GA
30349
US

IV. Provider business mailing address

1897 GODBY ROAD
COLLEGE PARK GA
30349
US

V. Phone/Fax

Practice location:
  • Phone: 404-300-9657
  • Fax: 404-344-6991
Mailing address:
  • Phone: 404-300-9657
  • Fax: 404-344-6911

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QB0002X
TaxonomyObesity Medicine (Family Medicine) Physician
License Number031032
License Number StateGA

VIII. Authorized Official

Name: VICKIE ANN JAMES
Title or Position: CEO/OWNER
Credential: M.D.
Phone: 404-300-9657