Healthcare Provider Details

I. General information

NPI: 1710946371
Provider Name (Legal Business Name): MEDICAL CENTRE OF CONYERS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/22/2006
Last Update Date: 12/22/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1445 OLD MCDONOUGH HWY SE STE E
CONYERS GA
30094-5977
US

IV. Provider business mailing address

1445 OLD MCDONOUGH HWY SE STE E
CONYERS GA
30094-5977
US

V. Phone/Fax

Practice location:
  • Phone: 770-922-9222
  • Fax: 770-922-8794
Mailing address:
  • Phone: 770-922-9222
  • Fax: 770-922-8794

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: STEPHEN F FELTON
Title or Position: PRESIDENT
Credential: MD
Phone: 770-922-9222