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General NPI Number Information
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NPI Number | 1528835519
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Entity Type | Organization
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Legal Business Name | FIRST VISIT MD
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Dates
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Enumeration Date | 12/08/2023
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Last Update Date | 12/08/2023
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Provider Practice Location Address
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Address Line | 3101 COBB PKWY SE STE 124
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City | ATLANTA
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State | GA
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Zip | 30339-3497
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Country | US
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Telephone | 757-418-4131
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 3413
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City | SAINT CHARLES
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State | IL
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Zip | 60174-9093
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Country | US
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Telephone |
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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. JASON ASHLEY
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Credential |
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Telephone | 404-477-8701
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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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