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General NPI Number Information
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NPI Number | 1275724486
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Entity Type | Organization
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Legal Business Name | LONG HAUL CLINIC, LLC
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Dates
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Enumeration Date | 08/05/2007
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Last Update Date | 08/05/2007
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Provider Practice Location Address
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Address Line | 10945 STATE BRIDGE RD SUITE 401, ROOM 358
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City | ALPHARETTA
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State | GA
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Zip | 30022-8164
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Country | US
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Telephone | 678-749-7803
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Fax |
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Provider Business Mailing Address
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Address Line | 10945 STATE BRIDGE RD SUITE 401, ROOM 358
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City | ALPHARETTA
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State | GA
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Zip | 30022-8164
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Country | US
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Telephone | 678-749-7803
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Fax |
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Authorized Official
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Title or Position | COO
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Name | MR. KEN KAREGEANNES
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Credential |
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Telephone | 678-749-7803
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QU0200X
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Taxonomy Name | Urgent Care Clinic/Center
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License Number |
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License Number State |
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