Organization
EXECUTIVE MEDICAL ASSOCIATES P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LEE WILKES M.D. (OWNER/MEDICAL DIRECTOR)
(770) 572-7574
Entity
Organization
Contact information
Practice address
4426 HUGH HOWELL RD, SUITE B303, TUCKER, GA 30084-4918
(770) 572-7574
Mailing address
59 BEAMS WAY, DALLAS, GA 30157-2517
(678) 779-7038
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
RN162951
GA
Other
Enumeration date
05/08/2015
Last updated
05/08/2015
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