Organization
HAMILTON MILL FAMILY COMPLETE CARE, LLC
Active
Parent organization
COVENANT MEDICAL CENTER, P.C.
Organization subpart
Yes
Provider details
NPI number
Legal business name
COVENANT MEDICAL CENTER, P.C.
Authorized official
MR. RUSSELL GLASSMAN (MEMBER/MANAGER)
(770) 614-6630
Entity
Organization
Contact information
Practice address
3509 BRASELTON HWY, BUILDING F, DACULA, GA 30019-1107
(770) 614-6630
(770) 614-6684
Mailing address
3509 BRASELTON HWY, BUILDING F, DACULA, GA 30019-1107
(770) 614-6630
(770) 614-6684
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
07581
GA
207R00000X
Internal Medicine Physician
Primary
—
—
363L00000X
Nurse Practitioner
176596
GA
Other
Enumeration date
12/13/2011
Last updated
12/13/2011
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