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General NPI Number Information
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NPI Number | 1679755029
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Entity Type | Organization
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Legal Business Name | INTERNAL MEDICINE SPECIALISTS
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Dates
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Enumeration Date | 11/28/2007
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Last Update Date | 11/28/2007
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Provider Practice Location Address
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Address Line | 721 WELLNESS WAY SUITE 100
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City | LAWRENCEVILLE
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State | GA
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Zip | 30045-3304
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Country | US
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Telephone | 770-709-0900
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Fax |
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Provider Business Mailing Address
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Address Line | 721 WELLNESS WAY SUITE 100
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City | LAWRENCEVILLE
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State | GA
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Zip | 30045-3304
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Country | US
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Telephone | 770-709-0900
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Fax |
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | DORA CAULFIELD
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Credential |
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Telephone | 770-709-0900
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 034236
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License Number State | GA
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