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General NPI Number Information
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NPI Number | 1124051636
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Entity Type | Organization
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Legal Business Name | STOCKBRIDGE FAMILY CARE CENTER
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Dates
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Enumeration Date | 07/08/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1231 EAGLES LANDING PKWY SUITE A
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City | STOCKBRIDGE
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State | GA
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Zip | 30281-5013
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Country | US
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Telephone | 404-207-1860
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Fax | 404-207-1864
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Provider Business Mailing Address
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Address Line | 1231 EAGLES LANDING PKWY SUITE A
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City | STOCKBRIDGE
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State | GA
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Zip | 30281-5013
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Country | US
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Telephone | 404-207-1860
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Fax | 404-207-1864
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | SUSANA VEGA
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Credential |
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Telephone | 404-207-1860
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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 | 053736
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License Number State | GA
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