Organization
EAGLES LANDING MEDICAL CENTER
Active
Other names
MULTI SPECIALIST PRACTICE
Organization subpart
No
Provider details
NPI number
Authorized official
SHARON SELENA DUNCAN (CREDENTIALING SPECIALIST)
(678) 656-7203
Entity
Organization
Contact information
Practice address
1215 EAGLES LANDING PKWY STE 205, STOCKBRIDGE, GA 30281-7280
(770) 389-9116
Mailing address
1215 EAGLES LANDING PKWY STE 205, STOCKBRIDGE, GA 30281-7280
(770) 389-9116
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
52394
GA
207Q00000X
Family Medicine Physician
Primary
—
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1144255399
NPI NUMBER
GA
Enumeration date
12/22/2015
Last updated
01/05/2016
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