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General NPI Number Information
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NPI Number | 1023768090
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Entity Type | Organization
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Legal Business Name | EXPRESS CLINIC, LLC
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Dates
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Enumeration Date | 03/24/2022
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Last Update Date | 08/23/2023
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Provider Practice Location Address
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Address Line | 3350 STEVE REYNOLDS BLVD STE 408
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City | DULUTH
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State | GA
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Zip | 30096
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Country | US
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Telephone | 678-783-4449
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Fax |
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Provider Business Mailing Address
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Address Line | 3628 SATELLITE BLVD UNIT 958236
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City | DULUTH
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State | GA
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Zip | 30095-0489
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | SOLOMON MATOVU
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Credential |
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Telephone | 678-783-4927
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number |
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License Number State |
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