Organization
ELITE FAMILY PRACTICE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DELANIA W MILES (OFFICE MANAGER)
(678) 715-2993
Entity
Organization
Contact information
Practice address
6126 PRESTLEY MILL RD, SUITE H, DOUGLASVILLE, GA 30134-5623
(678) 715-2993
(678) 715-2827
Mailing address
6126 PRESTLEY MILL RD, SUITE H, DOUGLASVILLE, GA 30134-5623
(678) 715-2993
(678) 715-2827
Taxonomy
Speciality
Code
Description
License number
State
305R00000X
Preferred Provider Organization
Primary
041745
GA
Other
Enumeration date
09/05/2012
Last updated
09/05/2012
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