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Organization
CENTER FOR GENERAL MEDICINE INC
Active
Organization
CENTER FOR GENERAL MEDICINE INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BETH ROLLOLAZO (OFFICE MANAGER)
(770) 456-9993
Entity
Organization
Contact information
Practice address
809 W. HWY 78, SUITE D, VILLA RICA, GA 30180-1520
(770) 456-9996
(770) 456-9949
Mailing address
809 W. HWY 78, SUITE D, VILLA RICA, GA 30180-1520
(770) 456-9996
(770) 456-9949
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
Primary
17551
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000113433G
—
GA
05
—
000114133H
—
GA
01
—
DP5724
RAILROAD MEDICARE CGM,INC
GA
01
—
P00425023
MEDICARE RAILROAD PIN
GA
Enumeration date
10/21/2008
Last updated
07/13/2010
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