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Organization
PRODIAGNOSTICS MEDICAL CENTER
Active
Organization
PRODIAGNOSTICS MEDICAL CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CARLOS ALBERTO ESCOBAR (FAMILY NURSE PRACTICIONER)
(770) 880-4517
Entity
Organization
Contact information
Practice address
6460 HIGHWAY 92 STE 200, ACWORTH, GA 30102-2998
(678) 915-1891
Mailing address
6460 HIGHWAY 92 STE 200, ACWORTH, GA 30102-2998
(678) 915-1891
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
RN225443
GA
Other
Enumeration date
10/02/2017
Last updated
10/02/2017
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