# CLARKSTON PRIMARY & URGENT CARE, LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** CLARKSTON PRIMARY & URGENT CARE LLC, CLARKSTON PRIMARY & URGENT CARE LLC
- **Organization subpart:** No

## Provider details

- **NPI number:** 1043781420
- **Authorized official:** MS. ETSUBDENKE AREAYA FNP-C (AUTHORIZED OFFICIAL)
- **Authorized official phone:** (678) 763-2247

## Contact information

- **Practice address:** 4600 E PONCE DE LEON AVE STE A, CLARKSTON, GA 30021-1839
- **Practice address phone:** (770) 703-5408
- **Practice address fax:** (877) 779-5837
- **Mailing address:** 4600 E PONCE DE LEON AVE STE A, CLARKSTON, GA 30021-1839
- **Mailing address phone:** (770) 703-5408
- **Mailing address fax:** (877) 779-5837

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | NULL | Yes |
| 207Q00000X | Family Medicine Physician | — | — | Yes |

## Other

- **Enumeration date:** 12/11/2018
- **Last updated:** 12/11/2018