Organization
ESTATE CLINICS BY CMG
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KAYLENE MARTIN (PRACTICE MANAGER)
(770) 990-8212
Entity
Organization
Contact information
Practice address
107 UPPER RIVERDALE RD SW, RIVERDALE, GA 30274-2504
(770) 997-2160
Mailing address
483 UPPER RIVERDALE RD SW STE F, RIVERDALE, GA 30274-2579
(770) 742-3883
(855) 597-8504
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
—
—
261QM1300X
Multi-Specialty Clinic/Center
—
—
261QR1100X
Research Clinic/Center
—
—
261QU0200X
Urgent Care Clinic/Center
—
—
Other
Enumeration date
09/24/2021
Last updated
09/24/2021
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