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General NPI Number Information
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NPI Number | 1285401901
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Entity Type | Organization
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Legal Business Name | LA CLINIQUE LLC
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Dates
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Enumeration Date | 12/04/2023
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Last Update Date | 08/25/2025
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Provider Practice Location Address
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Address Line | 1240 N THORNTON AVE
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City | DALTON
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State | GA
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Zip | 30720-3605
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Country | US
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Telephone | 706-229-9313
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Fax | 706-229-9388
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Provider Business Mailing Address
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Address Line | 1240 N THORNTON AVE
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City | DALTON
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State | GA
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Zip | 30720-3605
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Country | US
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Telephone | 706-229-9313
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Fax | 706-229-9388
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Authorized Official
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Title or Position | OWNER
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Name | RAMSES VEGA-CASASNOVAS
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Credential | MD
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Telephone | 336-688-6240
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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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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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