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General NPI Number Information
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NPI Number | 1154859817
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Entity Type | Organization
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Legal Business Name | MDVIP MEDICAL GROUP GA-ATL
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Dates
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Enumeration Date | 05/25/2017
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Last Update Date | 03/21/2023
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Provider Practice Location Address
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Address Line | 1800 HOWELL MILL RD NW STE 525
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City | ATLANTA
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State | GA
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Zip | 30318-2538
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Country | US
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Telephone | 404-537-8081
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Fax | 404-367-3085
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Provider Business Mailing Address
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Address Line | 1800 HOWELL MILL RD NW STE 525
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City | ATLANTA
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State | GA
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Zip | 30318-3188
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Country | US
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Telephone | 404-537-8081
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Fax | 404-367-3085
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Authorized Official
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Title or Position | CHIEF MEDICAL OFFICER
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Name | ANDREA KLEMES
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Credential | DO
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Telephone | 561-982-4300
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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