Organization
SOUTH ATLANTA PRIMARY CARE PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MICHAEL ANGEL DICRISTINA MD (PHYSICIAN OWNER)
(770) 968-7933
Entity
Organization
Contact information
Practice address
6568A TARA BLVD, JONESBORO, GA 30236-1228
(770) 968-7933
(770) 968-6521
Mailing address
6568A TARA BLVD, JONESBORO, GA 30236-1228
(770) 968-7933
(770) 968-6521
Taxonomy
Speciality
Code
Description
License number
State
173000000X
Legal Medicine
Primary
022223
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1144226135
IND NPI NUMBER
GA
Enumeration date
06/21/2007
Last updated
08/22/2020
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