Organization
MCINTOSH TRAIL FAMILY PRACTICE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DAVID A VAN M.D. (OWNER)
(770) 228-5407
Entity
Organization
Contact information
Practice address
747 S HILL ST, GRIFFIN, GA 30224-4830
(770) 228-5407
(770) 227-1430
Mailing address
747 S HILL ST, GRIFFIN, GA 30224-4830
(770) 228-5407
(770) 227-1430
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
029545
GA
Other
Enumeration date
05/03/2007
Last updated
01/07/2010
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