Organization
PEACHSTATE FAMILY CLINIC, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. CHANGCHUN WU MD (PHYSICIAN)
(678) 583-8888
Entity
Organization
Contact information
Practice address
4319 LAWRENCEVILLE HWY NW, LILBURN, GA 30047-3416
(678) 583-8888
Mailing address
4319 LAWRENCEVILLE HWY NW, LILBURN, GA 30047-3416
(678) 583-8888
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
061537
GA
Other
Enumeration date
11/17/2017
Last updated
11/17/2017
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