Organization
ALLCARE HEALTH CLINIC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JEAN BASTIA NP (NURSE PRACTITIONER)
(678) 425-4030
Entity
Organization
Contact information
Practice address
2220 ATLANTA RD SE, SMYRNA, GA 30080-1583
(770) 970-0024
Mailing address
4387 LAURIAN DR NW, KENNESAW, GA 30144-5147
(678) 425-4030
Taxonomy
Speciality
Code
Description
License number
State
261QP2300X
Primary Care Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
202I508719
MEDICARE
GA
05
—
202I508719
—
GA
Enumeration date
02/23/2018
Last updated
02/23/2018
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