Organization
IDLEWOOD MEDICAL CLINIC INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
AIDA ROSA DE LA VEGA (CEO)
(305) 388-4383
Entity
Organization
Contact information
Practice address
2157 IDLEWOOD RD, STE B, TUCKER, GA 30084-4832
(305) 388-4383
(305) 388-4380
Mailing address
2157 IDLEWOOD RD, STE B, TUCKER, GA 30084-4832
(305) 388-4383
(305) 388-4380
Taxonomy
Speciality
Code
Description
License number
State
207QA0505X
Adult Medicine Physician
Primary
—
—
Other
Enumeration date
11/29/2010
Last updated
12/17/2010
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