Organization
MCDONOUGH PRIMARY CARE INC
Active
Other names
Keys Ferry Medical Center
Organization subpart
No
Provider details
NPI number
Authorized official
DR. WILLIAM HARRELL VAN LAAR DO (OWNER)
(770) 914-0342
Entity
Organization
Contact information
Practice address
68 HAMPTON ST, MCDONOUGH, GA 30253-3150
(770) 914-0342
(770) 914-0493
Mailing address
68 HAMPTON ST, MCDONOUGH, GA 30253-3150
(770) 914-0342
(770) 914-0493
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000458455E
—
GA
Enumeration date
11/10/2006
Last updated
11/09/2007
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