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General NPI Number Information
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NPI Number | 1831583277
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Entity Type | Organization
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Legal Business Name | CLEAR CHOICE FAMILY MEDICINE, INC
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Dates
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Enumeration Date | 03/24/2015
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Last Update Date | 03/27/2015
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Provider Practice Location Address
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Address Line | 555 OLD NORCROSS RD SUITE 100
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City | LAWRENCEVILLE
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State | GA
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Zip | 30046-8716
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Country | US
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Telephone | 770-686-8857
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Fax | 404-341-9941
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Provider Business Mailing Address
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Address Line | 555 OLD NORCROSS RD SUITE 100
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City | LAWRENCEVILLE
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State | GA
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Zip | 30046-8716
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Country | US
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Telephone | 770-686-8857
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Fax | 404-341-9941
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Authorized Official
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Title or Position | INSURANCE MANAGER
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Name | MRS. PHARONDA LEE
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Credential |
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Telephone | 770-686-8857
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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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 | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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