Organization
GEORGIA STARS MEDICAL CLINIC, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. QUOC VINH NGO MD (OWNER)
(706) 885-1900
Entity
Organization
Contact information
Practice address
142 OLD MILL RD, LAGRANGE, GA 30241-6704
(706) 885-1900
(706) 882-1350
Mailing address
142 OLD MILL RD, LAGRANGE, GA 30241-6704
(706) 885-1900
(706) 882-1350
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
80387
MEDICAL LICENSE
GA
Enumeration date
08/28/2019
Last updated
08/28/2019
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