# CENTER FOR GENERAL MEDICINE INC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1184876294
- **Authorized official:** BETH ROLLOLAZO (OFFICE MANAGER)
- **Authorized official phone:** (770) 456-9993

## Contact information

- **Practice address:** 809 W. HWY 78, SUITE D, VILLA RICA, GA 30180-1520
- **Practice address phone:** (770) 456-9996
- **Practice address fax:** (770) 456-9949
- **Mailing address:** 809 W. HWY 78, SUITE D, VILLA RICA, GA 30180-1520
- **Mailing address phone:** (770) 456-9996
- **Mailing address fax:** (770) 456-9949

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208D00000X | General Practice Physician | 17551 | GA | Yes |

## Other

- **Enumeration date:** 10/21/2008
- **Last updated:** 07/13/2010

## 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 |