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General NPI Number Information
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NPI Number | 1659874287
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Entity Type | Organization
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Legal Business Name | BLISS PRIMARY AND URGENT CARE PC
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Dates
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Enumeration Date | 03/09/2018
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Last Update Date | 03/09/2018
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Provider Practice Location Address
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Address Line | 4600 E PONCE DE LEON AVE STE A
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City | CLARKSTON
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State | GA
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Zip | 30021-1839
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Country | US
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Telephone | 404-808-2125
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Fax | 877-779-5837
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Provider Business Mailing Address
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Address Line | 4600 E PONCE DE LEON AVE STE A
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City | CLARKSTON
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State | GA
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Zip | 30021-1839
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Country | US
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Telephone | 404-808-2125
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Fax | 877-779-5837
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Authorized Official
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Title or Position | AUTHORIZED OFFICIAL
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Name | DR. MILES JOHNSON
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Credential | MD
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Telephone | 404-664-4578
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QU0200X
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Taxonomy Name | Urgent Care Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number |
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License Number State |
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