Organization
STONE MOUNTAIN IMMEDIATE MEDICAL CARE, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. DORIS LYNN DAVIS (CREDENTIALING MGR)
(770) 879-5553
Entity
Organization
Contact information
Practice address
833 N HAIRSTON RD, STONE MOUNTAIN, GA 30083-3423
(770) 879-5553
(770) 879-5592
Mailing address
833 N HAIRSTON RD, STONE MOUNTAIN, GA 30083-3423
(770) 879-5553
(770) 879-5592
Taxonomy
Speciality
Code
Description
License number
State
302R00000X
Health Maintenance Organization
Primary
038143
GA
302R00000X
Health Maintenance Organization
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000703359I
—
GA
Enumeration date
06/27/2005
Last updated
11/20/2022
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