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General NPI Number Information
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NPI Number | 1174989594
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Entity Type | Organization
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Legal Business Name | GETTYSBURG MEDICAL CLINIC INC
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Dates
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Enumeration Date | 01/14/2016
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Last Update Date | 01/14/2016
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Provider Practice Location Address
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Address Line | 1834 BELLEVUE RD
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City | ATWATER
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State | CA
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Zip | 95301-2670
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Country | US
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Telephone | 209-285-9688
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Fax | 209-725-2072
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Provider Business Mailing Address
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Address Line | 1834 BELLEVUE RD
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City | ATWATER
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State | CA
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Zip | 95301-2670
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Country | US
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Telephone | 209-285-9688
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Fax | 209-725-2072
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | DR. JOHNNY YEE FONG
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Credential | M.D.
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Telephone | 559-259-1982
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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 | A26653
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License Number State | CA
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