Organization
OLD NATIONAL PRIMARY CARE CLINIC, LLC
Active
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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