Healthcare Provider Details

I. General information

NPI: 1699904219
Provider Name (Legal Business Name): PHYSICIANS IMMEDIATE MED OF JOHNS CREEK PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/02/2009
Last Update Date: 11/19/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2575 PEACHTREE PKWY SUITE 100
CUMMING GA
30041-7559
US

IV. Provider business mailing address

2575 PEACHTREE PKWY SUITE 100
CUMMING GA
30041-7559
US

V. Phone/Fax

Practice location:
  • Phone: 770-888-8777
  • Fax: 770-888-8779
Mailing address:
  • Phone: 770-888-8777
  • Fax: 770-888-8779

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207PE0005X
TaxonomyUndersea and Hyperbaric Medicine (Emergency Medicine) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP3300X
TaxonomyPain Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. JAMES A YOST
Title or Position: CEO, PRESIDENT
Credential: M.D.
Phone: 770-888-8777