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General NPI Number Information
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NPI Number | 1609820745
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Entity Type | Organization
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Legal Business Name | CHAMBLEE MEDICAL CLINIC
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Dates
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Enumeration Date | 05/22/2006
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Last Update Date | 02/25/2008
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Provider Practice Location Address
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Address Line | 3739 CHAMBLEE DUNWOODY RD
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City | CHAMBLEE
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State | GA
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Zip | 30341-2062
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Country | US
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Telephone | 770-458-0025
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Fax | 770-458-0807
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Provider Business Mailing Address
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Address Line | PO BOX 80042
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City | ATLANTA
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State | GA
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Zip | 30366-0042
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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 | SOREN THOMAS
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Credential |
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Telephone | 770-458-0025
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332900000X
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Taxonomy Name | Non-Pharmacy Dispensing Site
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License Number | 026895
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License Number State | GA
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