Healthcare Provider Details

I. General information

NPI: 1609816123
Provider Name (Legal Business Name): GEORGIA CLINIC, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/07/2006
Last Update Date: 12/16/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1861 PEELER RD
DUNWOODY GA
30338-5714
US

IV. Provider business mailing address

PO BOX 769609
ROSWELL GA
30076-8224
US

V. Phone/Fax

Practice location:
  • Phone: 770-730-5800
  • Fax: 770-730-5803
Mailing address:
  • Phone: 770-730-5800
  • Fax: 770-730-5803

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number StateGA

VIII. Authorized Official

Name: NARESH K. PARIKH
Title or Position: CEO
Credential: M.D.
Phone: 770-903-0120