Organization
FAMILY MEDICAL CENTER (HOLDING) P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SALLU JABATI MD (CEO)
(678) 559-4526
Entity
Organization
Contact information
Practice address
5615 OLD NATIONAL HWY, COLLEGE PARK, GA 30349-3811
(770) 997-2900
Mailing address
5615 OLD NATIONAL HWY, COLLEGE PARK, GA 30349-3811
(770) 997-2900
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
—
—
207RA0000X
Adolescent Medicine (Internal Medicine) Physician
Primary
058527
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
712681970B
—
GA
Enumeration date
07/30/2015
Last updated
07/30/2015
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