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General NPI Number Information
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NPI Number | 1992849988
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Entity Type | Organization
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Legal Business Name | ASSOCIATED PHYSICIANS
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Dates
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Enumeration Date | 02/16/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 5579 MABLETON PKWY SE
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City | MABLETON
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State | GA
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Zip | 30126
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Country | US
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Telephone | 770-948-1049
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Fax | 770-948-6522
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Provider Business Mailing Address
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Address Line | 5579 MABLETON PKWY SE
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City | MABLETON
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State | GA
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Zip | 30126-3301
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Country | US
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Telephone | 770-948-1049
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Fax | 770-948-6522
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MRS. SHAWN WISE
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Credential |
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Telephone | 770-948-1049
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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 | 029961
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License Number State | GA
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