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General NPI Number Information
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NPI Number | 1467044529
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Entity Type | Organization
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Legal Business Name | PICKENS PRIMARY CARE LLC
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Dates
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Enumeration Date | 02/09/2021
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Last Update Date | 03/11/2021
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Provider Practice Location Address
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Address Line | 744 NOAH DR # 108-109
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City | JASPER
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State | GA
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Zip | 30143-8705
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Country | US
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Telephone | 706-692-0119
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Fax |
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Provider Business Mailing Address
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Address Line | 790 CHAMPIONS CLUB DR
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City | ALPHARETTA
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State | GA
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Zip | 30004-6955
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Country | US
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Telephone | 404-984-8357
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MR. JESUS VAZQUEZ-FIGUEROA
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Credential | MD
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Telephone | 706-692-0119
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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 |
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License Number State |
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