Organization
ELEVEN 11 MEDICAL MANAGEMENT, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. CYNTHIA TATE (ADMINISTRATOR)
(678) 235-2401
Entity
Organization
Contact information
Practice address
438 HENRY FORD II AVE, HAPEVILLE, GA 30354-1622
(678) 235-2401
(678) 235-2403
Mailing address
438 HENRY FORD II AVE, HAPEVILLE, GA 30354-1622
(678) 235-2401
(678) 235-2403
Taxonomy
Speciality
Code
Description
License number
State
207KA0200X
Allergy Physician
Primary
—
—
Other
Enumeration date
03/09/2012
Last updated
03/09/2012
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