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General NPI Number Information
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NPI Number | 1104959485
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Entity Type | Organization
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Legal Business Name | HISPANIC MEDICAL MANAGEMENT
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Dates
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Enumeration Date | 03/14/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 5127 JIMMY CARTER BLVD
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City | NORCROSS
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State | GA
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Zip | 30093-1619
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Country | US
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Telephone | 770-613-0070
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Fax | 770-613-0909
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Provider Business Mailing Address
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Address Line | 5127 JIMMY CARTER BLVD
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City | NORCROSS
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State | GA
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Zip | 30093-1619
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Country | US
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Telephone | 770-613-0070
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Fax | 770-613-0909
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Authorized Official
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Title or Position | COO
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Name | MS. TRACEY COTA
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Credential |
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Telephone | 770-613-0070
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 291U00000X
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Taxonomy Name | Clinical Medical Laboratory
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License Number |
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License Number State |
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