# NORTH FULTON PRIMARY CARE - WYLIE BRIDGE, LLC

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

## Provider details

- **NPI number:** 1326472283
- **Authorized official:** MR. WESLEY O. JAMES (REGIONAL CFO, TENET)
- **Authorized official phone:** (404) 265-5009

## Contact information

- **Practice address:** 14205 HIGHWAY 92, SUITE 105, WOODSTOCK, GA 30188-7138
- **Practice address phone:** (678) 293-7854
- **Practice address fax:** (770) 740-8503
- **Mailing address:** PO BOX 742595, ATLANTA, GA 30374-2595
- **Mailing address phone:** (678) 293-7854
- **Mailing address fax:** (770) 740-8503

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | NULL | Yes |
| 207Q00000X | Family Medicine Physician | — | — | Yes |
| 2083P0011X | Undersea and Hyperbaric Medicine (Preventive Medicine) Physician | — | NULL | — |
| 2083P0011X | Undersea and Hyperbaric Medicine (Preventive Medicine) Physician | — | — | — |

## Other

- **Enumeration date:** 08/28/2013
- **Last updated:** 06/16/2016