Organization
POLARIS MEDICAL GROUP LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. LISA C PERRY-GILKES M.D. (CFO)
(404) 766-8110
Entity
Organization
Contact information
Practice address
1136 CLEVELAND AVE, ATLANTA, GA 30344
(404) 766-8110
(404) 766-8106
Mailing address
1136 CLEVELAND AVE, ATLANTA, GA 30344
(404) 766-8110
(404) 766-8106
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
052218
GA
174400000X
Specialist
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
442333125C
—
GA
Enumeration date
02/09/2007
Last updated
04/03/2009
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