Healthcare Provider Details

I. General information

NPI: 1902230329
Provider Name (Legal Business Name): PHYSICIAN'S EXPRESS CARE AT TOWNE LAKE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/22/2013
Last Update Date: 09/02/2021
Certification Date: 09/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 TOWNE LAKE PKWY STE 104
WOODSTOCK GA
30189-1603
US

IV. Provider business mailing address

1780 PEACHTREE PKWY STE 302
CUMMING GA
30041-6834
US

V. Phone/Fax

Practice location:
  • Phone: 770-772-1830
  • Fax: 770-693-5902
Mailing address:
  • Phone: 770-772-1830
  • Fax: 470-253-8215

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number51875
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number51875
License Number StateGA

VIII. Authorized Official

Name: DR. RICHARD G DUKES
Title or Position: OWNER
Credential: M.D.
Phone: 770-772-1830