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General NPI Number Information
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NPI Number | 1023484417
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Entity Type | Organization
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Legal Business Name | XPRESS CARE CLINIC OF GEORGIA, LLC
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Dates
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Enumeration Date | 08/19/2015
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Last Update Date | 01/19/2016
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Provider Practice Location Address
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Address Line | 963 BULLSBORO DR SUITE 4D
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City | NEWNAN
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State | GA
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Zip | 30265-6801
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Country | US
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Telephone | 770-252-6500
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Fax |
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Provider Business Mailing Address
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Address Line | 963 BULLSBORO DR SUITE 4D
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City | NEWNAN
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State | GA
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Zip | 30265-6801
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Country | US
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Telephone | 770-252-6500
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Fax |
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | DONALD LEWIS GRIFFIN
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Credential | M.D.
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Telephone | 770-252-6500
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | 027820
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License Number State | GA
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