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NPI Code Detail

MEDICARE: INTOWN FAMILY PRACTICE & SPORTS MEDICINE PC

MEDICARE: INTOWN FAMILY PRACTICE & SPORTS MEDICINE PC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1261QP2300XPrimary Care Clinic/Center20330NC
2261QP2300XPrimary Care Clinic/Center038777GA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1160928OTHERGACOVENTRY HEALTHCARE
252476640002OTHERGABCBS OF GA
30191191OTHERGAUNITED HEALTHCARE
44546534OTHERGAAETNA
51013698006OTHERGACIGNA HEALTHCARE
6776894OTHERGAFIRST HEALTH

General Provider Information

NPI Number : 1235446394
Entity Type Code : Organization
Provider Name (Legal Business Name) : INTOWN FAMILY PRACTICE & SPORTS MEDICINE PC
Provider Business Mailing Address
First Line : 285 BOULEVARD AVE NE
Second Line : SUITE 640
City : ATLANTA
State : GA
Zip : 30312-4212
Country : US
Telephone Number : 404-577-7800
Fax Number : 404-577-7810
Provider Business Practice Location Address
First Line : 285 BOULEVARD AVE NE
Second Line : SUITE 640
City : ATLANTA
State : GA
Zip : 30312-4212
Country : US
Telephone Number : 404-577-7800
Fax Number : 404-577-7810
Authorized Official
Title or Position : OWNER
Name : LAWRENCE LEO GOLUSINSKI JR.
Credential : M.D.
Telephone Number : 404-577-7800
Provider Enumeration Date : 09/09/2010
Last Update Date : 09/09/2010

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Directions to “INTOWN FAMILY PRACTICE & SPORTS MEDICINE PC ” Practice Location

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