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General NPI Number Information
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NPI Number | 1972056380
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Entity Type | Organization
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Legal Business Name | ROMULUS PRIMARY CARE SERVICES LLC
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Dates
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Enumeration Date | 08/02/2016
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Last Update Date | 07/11/2024
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Provider Practice Location Address
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Address Line | 4439 AUSTELL RD
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City | AUSTELL
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State | GA
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Zip | 30106-1839
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Country | US
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Telephone | 770-675-7407
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Fax | 770-693-5922
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Provider Business Mailing Address
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Address Line | 675 CHESTATEE CREEK DR NW
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City | ACWORTH
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State | GA
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Zip | 30101-3598
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Country | US
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Telephone | 678-977-6919
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Fax |
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Authorized Official
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Title or Position | CREDENTIALING MANAGER
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Name | SHAWNTREL MONIQUE WATTS
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Credential |
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Telephone | 770-679-5812
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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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