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General NPI Number Information
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NPI Number | 1073057915
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Entity Type | Organization
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Legal Business Name | DORAVILLE MEDICAL CENTER CORP
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Dates
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Enumeration Date | 12/12/2016
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Last Update Date | 12/12/2016
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Provider Practice Location Address
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Address Line | 5953 BUFORD HWY NE STE 208
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City | DORAVILLE
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State | GA
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Zip | 30340-1375
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Country | US
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Telephone | 678-580-3013
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Fax | 678-580-3096
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Provider Business Mailing Address
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Address Line | 5953 BUFORD HWY NE STE 208
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City | DORAVILLE
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State | GA
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Zip | 30340-1375
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Country | US
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Telephone | 678-580-3013
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Fax | 678-580-3096
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Authorized Official
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Title or Position | OWNER
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Name | EVELYN CUZA
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Credential |
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Telephone | 678-580-3013
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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