Organization
MID PHYSICIAN NETWORK (KY), LLC
Active
Parent organization
MYIDEALDOCTOR, LLC
Organization subpart
Yes
Provider details
NPI number
Legal business name
MYIDEALDOCTOR, LLC
Authorized official
ADRIAN DAVIS (CEO)
(678) 491-2804
Entity
Organization
Contact information
Practice address
5665 NEW NORTHSIDE DR, SUITE 520, ATLANTA, GA 30328-5831
(678) 491-2804
Mailing address
5665 NEW NORTHSIDE DR, SUITE 520, ATLANTA, GA 30328-5831
(678) 491-2804
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
Primary
—
—
Other
Enumeration date
11/23/2016
Last updated
11/23/2016
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