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Organization

GENESIS FAMILY MEDICINE & AESTHETICS, LLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
MARIBEL CHAVEZ (CEO/CFO)
(678) 262-8242
Entity
Organization

Contact information

Practice address
7316 SPOUT SPRINGS RD, SUITE 201, FLOWERY BRANCH, GA 30542-5665
(678) 262-8242
Mailing address
7316 SPOUT SPRINGS RD, SUITE 201, FLOWERY BRANCH, GA 30542-5665
(678) 262-8242

Taxonomy

Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
33410
GA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
000647006A
GA
Enumeration date
09/29/2016
Last updated
09/29/2016
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