Organization
SYNERGY MEDICAL CENTERS, LLC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. VINCENT BUBOLO (OWNER)
(770) 975-1299
Entity
Organization
Contact information
Practice address
3889 COBB PKWY NW, ACWORTH, GA 30101-4084
(770) 975-1299
(770) 975-1361
Mailing address
3889 COBB PKWY NW, ACWORTH, GA 30101-4084
(770) 975-1299
(770) 975-1361
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
018938
GA
174400000X
Specialist
PT006876
GA
332B00000X
Durable Medical Equipment & Medical Supplies
5860470001
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
5860470001
CIGNA GOVERNMENT SERVICES
GA
01
—
DC7392
RAILROAD PTAN
GA
Enumeration date
05/17/2006
Last updated
01/27/2010
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