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General NPI Number Information
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NPI Number | 1912948217
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Entity Type | Organization
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Legal Business Name | PHYSICIANS' IMMEDIATE MED
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Dates
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Enumeration Date | 06/09/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 3551 SATELLITE BLVD
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City | DULUTH
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State | GA
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Zip | 30096-4646
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Country | US
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Telephone | 770-476-3000
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Fax | 770-476-4066
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Provider Business Mailing Address
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Address Line | 3551 SATELLITE BLVD
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City | DULUTH
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State | GA
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Zip | 30096-4646
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Country | US
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Telephone | 770-476-3000
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Fax | 770-476-4066
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Authorized Official
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Title or Position | BRANCH MANAGER/CREDENTIALING
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Name | LORETTA P HART
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Credential |
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Telephone | 770-476-3000
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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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