MEDICARE: SANDY SPRINGS FAMILY MEDICINE AND URGENT CARE

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	261QM1300X	Multi-Specialty Clinic/Center	67209	GA

General Provider Information

NPI Number	:	1639594757
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SANDY SPRINGS FAMILY MEDICINE AND URGENT CARE

Provider Business Mailing Address
First Line	:	516 HIGHLAND PARK TRL
Second Line	:
City	:	SANDY SPRINGS
State	:	GA
Zip	:	30350-6701
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	8640 ROSWELL RD
Second Line	:
City	:	SANDY SPRINGS
State	:	GA
Zip	:	30350
Country	:	US
Telephone Number	:	770-906-2396
Fax Number	:

Authorized Official
Title or Position	:	MD
Name	:	BEATRIS DRAGONU
Credential	:
Telephone Number	:	770-676-7251

Provider Enumeration Date	:	02/26/2014
Last Update Date	:	02/26/2014

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