Organization
MY DOCTORS CLINIC LLC
Active
Other names
Peach Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
KETAN GHIA (MANAGER)
(678) 473-0715
Entity
Organization
Contact information
Practice address
2320 ATLANTA HWY, SUITE - 105, CUMMING, GA 30040-6339
(678) 473-0715
Mailing address
1754 MORNINGDALE CIR, NONE, DULUTH, GA 30097-5260
(678) 473-0715
Taxonomy
Speciality
Code
Description
License number
State
173000000X
Legal Medicine
052826
GA
207Q00000X
Family Medicine Physician
Primary
61431
GA
207R00000X
Internal Medicine Physician
052826
GA
207RS0012X
Sleep Medicine (Internal Medicine) Physician
052826
GA
2080P0214X
Pediatric Pulmonology Physician
63536
GA
Other
Enumeration date
10/19/2013
Last updated
01/16/2014
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