Organization
OLD NATIONAL PRIMARY CARE CLINIC, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
EVA ISABELLE BEAULIEU M.D. (OWNER)
(786) 556-0495
Entity
Organization
Contact information
Practice address
5185 OLD NATIONAL HWY, ATLANTA, GA 30349-3244
(404) 763-9300
(404) 763-9306
Mailing address
1065 JODECO RD, STOCKBRIDGE, GA 30281-4953
(678) 284-6300
(678) 284-6336
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
066254
GA
Other
Enumeration date
10/26/2011
Last updated
05/10/2013
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