# PMC MEDICAL & DIAGNOSTICS, LLC

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

## Provider details

- **NPI number:** 1457692956
- **Authorized official:** MRS. MARY LEACH (TEAM FINANCE LEADER)
- **Authorized official phone:** (678) 736-6342

## Contact information

- **Practice address:** 4646 N SHALLOWFORD RD STE 100, ATLANTA, GA 30338-6308
- **Practice address phone:** (770) 392-9805
- **Mailing address:** 4646 N SHALLOWFORD RD STE 100, ATLANTA, GA 30338-6308
- **Mailing address phone:** (770) 392-9805

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208D00000X | General Practice Physician | 026769 | GA | Yes |
| 208D00000X | General Practice Physician | 038861 | GA | — |

## Other

- **Enumeration date:** 03/07/2013
- **Last updated:** 03/07/2013