Organization
CLINICA MEDICA FAMILIAR, LLP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JACK PATRICK DOURRON (OFFICE MANAGER)
(770) 996-9681
Entity
Organization
Contact information
Practice address
189 MEDICAL WAY, SUITE B, RIVERDALE, GA 30274-4905
(770) 996-9681
(770) 996-9683
Mailing address
189 MEDICAL WAY, SUITE B, RIVERDALE, GA 30274-4905
(770) 996-9681
(770) 996-9683
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
027722
GA
207V00000X
Obstetrics & Gynecology Physician
Primary
014308
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000136958I
—
GA
Enumeration date
05/04/2009
Last updated
05/04/2009
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