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General NPI Number Information
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NPI Number | 1922130012
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Entity Type | Organization
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Legal Business Name | CLASSICARE MEDICAL CONSULT PC, INC
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Dates
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Enumeration Date | 03/12/2007
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Last Update Date | 09/17/2019
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Provider Practice Location Address
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Address Line | 4904 TIMBER RIDGE DR STE 303
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City | DOUGLASVILLE
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State | GA
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Zip | 30135-1831
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Country | US
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Telephone | 770-489-5000
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Fax | 770-489-0305
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Provider Business Mailing Address
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Address Line | 4904 TIMBER RIDGE DR STE 303
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City | DOUGLASVILLE
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State | GA
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Zip | 30135-1831
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Country | US
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Telephone | 770-489-5000
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Fax | 770-489-0305
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. XIANGDONG YOU
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Credential | MD
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Telephone | 770-489-5000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 050465
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License Number State | GA
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