Healthcare Provider Details

I. General information

NPI: 1609700426
Provider Name (Legal Business Name): 360 MEDICAL GROUP GEORGIA INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/09/2026
Last Update Date: 07/17/2026
Certification Date: 07/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8735 DUNWOODY PL STE N
SANDY SPRINGS GA
30350-2995
US

IV. Provider business mailing address

8735 DUNWOODY PL STE N
SANDY SPRINGS GA
30350-2995
US

V. Phone/Fax

Practice location:
  • Phone: 215-326-1602
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: JAMES VILLAR
Title or Position: ADMINISTRATOR
Credential:
Phone: 773-645-1192