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General NPI Number Information
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NPI Number | 1356682959
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Entity Type | Organization
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Legal Business Name | FOUR CORNERS PRIMARY CARE CENTERS, INC.
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Dates
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Enumeration Date | 03/06/2013
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Last Update Date | 09/27/2013
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Provider Practice Location Address
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Address Line | 175 GWINNETT DR SUITE 213
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City | LAWRENCEVILLE
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State | GA
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Zip | 30046-8444
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Country | US
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Telephone | 770-279-3142
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Fax | 770-234-5210
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Provider Business Mailing Address
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Address Line | 5030 GEORGIA BELLE CT SUITE 2066
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City | NORCROSS
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State | GA
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Zip | 30093-2667
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Country | US
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Telephone | 770-279-3142
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Fax | 770-234-5210
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Authorized Official
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Title or Position | CFO
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Name | MS. SUSAN A JOHNSON
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Credential |
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Telephone | 770-279-3142
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QF0400X
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Taxonomy Name | Federally Qualified Health Center (FQHC)
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License Number |
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License Number State |
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