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General NPI Number Information
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NPI Number | 1902957152
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Entity Type | Organization
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Legal Business Name | MAXA INTERNAL MEDICINE ASSOCIATES PC
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Dates
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Enumeration Date | 01/15/2007
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Last Update Date | 07/19/2011
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Provider Practice Location Address
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Address Line | 3505 DULUTH PARK LN BUILDING 4, STE 400
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City | DULUTH
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State | GA
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Zip | 30096-3201
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Country | US
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Telephone | 678-597-3180
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Fax | 678-597-3181
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Provider Business Mailing Address
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Address Line | 3505 DULUTH PARK LN BUILDING 4, STE 400
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City | DULUTH
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State | GA
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Zip | 30096-3201
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Country | US
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Telephone | 678-597-3180
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Fax | 678-597-3181
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Authorized Official
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Title or Position | PRACTICE ADMINISTRATOR
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Name | ASHLEIGH MAXA
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Credential |
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Telephone | 678-597-3180
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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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