Organization
CREEKSIDE MEDICAL CLINIC LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. SHARMILA RAMPRASAD MD (DIRECTOR)
(770) 627-3986
Entity
Organization
Contact information
Practice address
3104 CREEKSIDE VILLAGE DR NW, SUITE 201, KENNESAW, GA 30144-2324
(770) 627-3986
(770) 872-0517
Mailing address
3104 CREEKSIDE VILLAGE DR NW, SUITE 201, KENNESAW, GA 30144-2324
(770) 627-3986
(770) 872-0517
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
839516023A
—
GA
Enumeration date
02/22/2010
Last updated
08/15/2022
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