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General NPI Number Information
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NPI Number | 1891183125
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Entity Type | Organization
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Legal Business Name | EXPRESS MEDICAL LLC
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Dates
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Enumeration Date | 01/09/2015
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Last Update Date | 01/09/2015
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Provider Practice Location Address
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Address Line | 931 LOWER FAYETTEVILLE RD SUITE J
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City | NEWNAN
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State | GA
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Zip | 30263-5790
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Country | US
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Telephone | 770-683-4772
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Fax | 770-683-4775
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Provider Business Mailing Address
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Address Line | 931 LOWER FAYETTEVILLE RD SUITE J
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City | NEWNAN
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State | GA
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Zip | 30263-5790
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Country | US
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Telephone | 770-683-4772
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Fax | 770-683-4775
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Authorized Official
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Title or Position | OWNER
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Name | VANESSA HOWELL-PHILIP
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Credential | NP
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Telephone | 770-683-4772
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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 | 142462
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License Number State | GA
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