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General NPI Number Information
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NPI Number | 1720230154
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Entity Type | Organization
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Legal Business Name | CITY OF EXCELLENCE EMERGENCY PHYSICIANS LLC
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Dates
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Enumeration Date | 10/16/2008
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Last Update Date | 08/20/2019
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Provider Practice Location Address
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Address Line | 200 INDUSTRIAL BLVD
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City | DUBLIN
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State | GA
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Zip | 31021-2981
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Country | US
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Telephone | 478-275-2000
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Fax |
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Provider Business Mailing Address
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Address Line | 13737 NOEL ROAD STE 1600
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City | CLEARWATER
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State | TX
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Zip | 33764-6576
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Country | US
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Telephone | 954-838-2371
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Fax |
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Authorized Official
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Title or Position | OFFICER
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Name | V KONDAS
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Credential |
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Telephone | 954-838-2371
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number |
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License Number State |
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