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General NPI Number Information
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NPI Number | 1689078842
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Entity Type | Organization
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Legal Business Name | SAN PABLO CLINIC, LLC
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Dates
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Enumeration Date | 10/17/2014
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Last Update Date | 10/17/2014
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Provider Practice Location Address
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Address Line | 1301 BROADRICK DR
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City | DALTON
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State | GA
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Zip | 30720-3008
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Country | US
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Telephone | 706-270-5990
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Fax | 706-270-5992
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Provider Business Mailing Address
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Address Line | 1910 KEYSTONE WAY
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City | DALTON
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State | GA
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Zip | 30720-4812
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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 | MEMBER/MANAGER
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Name | JULIA GARCIA
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Credential | MD
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Telephone | 706-313-9059
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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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