Organization
SOUTH FULTON PRIMARY CARE, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LOGAN ALLEN (VP CLIENT OPERATIONS)
(678) 252-2137
Entity
Organization
Contact information
Practice address
1203 CLEVELAND AVE, SUITE 1A, EAST POINT, GA 30344-3417
(404) 305-8900
(404) 305-8099
Mailing address
2220 WISTERIA DR, SUITE 208, SNELLVILLE, GA 30078-2656
(678) 252-2137
(678) 336-7099
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
046202
GA
Other
Enumeration date
12/04/2009
Last updated
12/04/2009
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