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Organization

NEW SNELLVILLE CLINIC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
MR. GARY C COUILLARD BSEE (OPERATIONS DIRECTOR)
(770) 736-1735
Entity
Organization

Contact information

Practice address
2331 HENRY CLOWER BLVD, SUITE A, SNELLVILLE, GA 30078-3155
(770) 736-1735
(770) 736-1228
Mailing address
2331 HENRY CLOWER BLVD, SUITE A, SNELLVILLE, GA 30078-3155
(770) 736-1735
(770) 736-1228

Taxonomy

Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
043268
GA
207RG0300X
Geriatric Medicine (Internal Medicine) Physician
043268
GA
208D00000X
General Practice Physician
043268
GA

Other

Enumeration date
03/04/2009
Last updated
03/04/2009
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