Organization
GRACE MEDICAL PRACTICE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. FIDELIA OSINUBI (PHYSICIAN)
(404) 861-0291
Entity
Organization
Contact information
Practice address
3885 PRINCETON LAKES WAY SW, SUITE 402, ATLANTA, GA 30331-5589
(404) 349-0496
Mailing address
PO BOX 20156, ATLANTA, GA 30325-0156
Taxonomy
Speciality
Code
Description
License number
State
261QP2300X
Primary Care Clinic/Center
Primary
GA061309
GA
Other
Enumeration date
01/07/2010
Last updated
01/07/2010
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