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General NPI Number Information
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NPI Number | 1568861326
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Entity Type | Organization
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Legal Business Name | GOOD SHEPHERD CLINIC
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Dates
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Enumeration Date | 08/18/2014
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Last Update Date | 08/18/2014
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Provider Practice Location Address
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Address Line | 6392 MURPHY DR
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City | MORROW
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State | GA
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Zip | 30260-1714
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Country | US
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Telephone | 770-960-5701
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Fax | 770-968-2701
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Provider Business Mailing Address
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Address Line | 6392 MURPHY DR PO BOX 6
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City | MORROW
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State | GA
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Zip | 30260-1714
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Country | US
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Telephone | 770-960-5701
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Fax | 770-968-2701
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Authorized Official
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Title or Position | CLINIC ADMINISTRATOR
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Name | LISA W PAGE
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Credential |
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Telephone | 770-960-5701
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QC1500X
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Taxonomy Name | Community Health Clinic/Center
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License Number |
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License Number State |
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