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Organization
IDEAL MEDICAL CENTER, LLC
Active
Organization
IDEAL MEDICAL CENTER, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. ALEX CAMPOS (OWNER / PRESIDENT)
(678) 812-2625
Entity
Organization
Contact information
Practice address
3523 BUFORD HWY NE, SUITE 100, ATLANTA, GA 30329-1201
(678) 812-2625
Mailing address
3039 PREMIERE PKWY, SUITE 100, DULUTH, GA 30097-4905
(678) 812-2625
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
—
NULL
183500000X
Pharmacist
—
—
207Q00000X
Family Medicine Physician
Primary
—
NULL
207Q00000X
Family Medicine Physician
Primary
—
—
207QA0000X
Adolescent Medicine (Family Medicine) Physician
—
NULL
207QA0000X
Adolescent Medicine (Family Medicine) Physician
—
—
207R00000X
Internal Medicine Physician
—
NULL
207R00000X
Internal Medicine Physician
—
—
207V00000X
Obstetrics & Gynecology Physician
—
NULL
207V00000X
Obstetrics & Gynecology Physician
—
—
208000000X
Pediatrics Physician
—
NULL
208000000X
Pediatrics Physician
—
—
225100000X
Physical Therapist
—
NULL
225100000X
Physical Therapist
—
—
Other
Enumeration date
01/23/2007
Last updated
01/22/2008
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