Organization
CLINICA SANTA MARIA LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. ANTONIO MENDOZA (CLINIC MANAGER)
(770) 928-8450
Entity
Organization
Contact information
Practice address
6158 HIGHWAY 92 STE 101, ACWORTH, GA 30102-2332
(770) 928-8450
(770) 928-8452
Mailing address
6158 HIGHWAY 92 STE 101, ACWORTH, GA 30102-2332
(770) 928-8450
(770) 928-8452
Taxonomy
Speciality
Code
Description
License number
State
261QH0100X
Health Service Clinic/Center
Primary
LC20110001409
GA
Other
Enumeration date
12/16/2011
Last updated
06/21/2012
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