MEDICARE: PHYSICIAN'S EXPRESS CARE AT CREEKSTONE

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
1	261QU0200X	Urgent Care Clinic/Center	51875	GA

General Provider Information

NPI Number	:	1578955795
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PHYSICIAN'S EXPRESS CARE AT CREEKSTONE

Provider Business Mailing Address
First Line	:	1780 PEACHTREE PKWY STE 3302
Second Line	:
City	:	CUMMING
State	:	GA
Zip	:	30041-6834
Country	:	US
Telephone Number	:	770-772-1830
Fax Number	:	470-239-7296

Provider Business Practice Location Address
First Line	:	1780 PEACHTREE PKWY STE 302
Second Line	:
City	:	CUMMING
State	:	GA
Zip	:	30041-6834
Country	:	US
Telephone Number	:	770-772-1830
Fax Number	:	470-239-7296

Authorized Official
Title or Position	:	OWNER
Name	:	DR. RICHARD G DUKES
Credential	:	M.D.
Telephone Number	:	770-772-1830

Provider Enumeration Date	:	02/25/2015
Last Update Date	:	09/02/2021

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