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General NPI Number Information
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NPI Number | 1235446394
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Entity Type | Organization
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Legal Business Name | INTOWN FAMILY PRACTICE & SPORTS MEDICINE PC
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Dates
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Enumeration Date | 09/09/2010
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Last Update Date | 09/09/2010
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Provider Practice Location Address
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Address Line | 285 BOULEVARD AVE NE SUITE 640
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City | ATLANTA
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State | GA
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Zip | 30312-4212
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Country | US
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Telephone | 404-577-7800
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Fax | 404-577-7810
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Provider Business Mailing Address
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Address Line | 285 BOULEVARD AVE NE SUITE 640
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City | ATLANTA
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State | GA
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Zip | 30312-4212
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Country | US
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Telephone | 404-577-7800
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Fax | 404-577-7810
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Authorized Official
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Title or Position | OWNER
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Name | LAWRENCE LEO GOLUSINSKI JR.
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Credential | M.D.
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Telephone | 404-577-7800
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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 | 20330
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | 038777
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License Number State | GA
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