Organization
FAMILY MEDICAL CLINIC OF SNELLVILLE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GORDON GLENN FREEMAN M.D. (PRESIDENT)
(770) 972-4764
Entity
Organization
Contact information
Practice address
3891 STONE MOUNTAIN HWY, SNELLVILLE, GA 30039-3932
(770) 972-4764
(770) 972-4164
Mailing address
3891 STONE MOUNTAIN HWY, SNELLVILLE, GA 30039-3932
(770) 972-4764
(770) 972-4164
Taxonomy
Speciality
Code
Description
License number
State
261QP2300X
Primary Care Clinic/Center
Primary
023958
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1083652267
IND. NPI
—
01
—
4073314
AETNA PROVIDER ID
GA
01
—
52260821001
BC PROVIDER ID
GA
Enumeration date
07/29/2008
Last updated
06/10/2015
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