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General NPI Number Information
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NPI Number | 1184876294
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Entity Type | Organization
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Legal Business Name | CENTER FOR GENERAL MEDICINE INC
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Dates
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Enumeration Date | 10/21/2008
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Last Update Date | 07/13/2010
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Provider Practice Location Address
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Address Line | 809 W. HWY 78 SUITE D
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City | VILLA RICA
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State | GA
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Zip | 30180-1520
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Country | US
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Telephone | 770-456-9996
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Fax | 770-456-9949
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Provider Business Mailing Address
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Address Line | 809 W. HWY 78 SUITE D
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City | VILLA RICA
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State | GA
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Zip | 30180-1520
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Country | US
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Telephone | 770-456-9996
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Fax | 770-456-9949
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | BETH ROLLOLAZO
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Credential |
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Telephone | 770-456-9993
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | 17551
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License Number State | GA
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