Organization
LAVISTA FAMILY MEDICINE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MIKHAIL GOROKHOV (FAMILY PRACTICE)
(404) 320-6050
Entity
Organization
Contact information
Practice address
2910 N DRUID HILLS RD NE, SUITE A, ATLANTA, GA 30329-3919
(404) 320-6050
(404) 320-6080
Mailing address
2012 HAROBI DR, SUITE B, TUCKER, GA 30084-5161
(404) 320-6050
(404) 320-6080
Taxonomy
Speciality
Code
Description
License number
State
261QP2300X
Primary Care Clinic/Center
Primary
039353
GA
261QP2300X
Primary Care Clinic/Center
042048
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000662219E
—
GA
Enumeration date
04/22/2008
Last updated
10/24/2013
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