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Organization

JW MEDICAL CARE, LLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
S. LOGAN ALLEN (PRACTICE MANAGER)
(678) 252-2137
Entity
Organization

Contact information

Practice address
2225 GODBY RD, COLLEGE PARK, GA 30349-5012
(404) 767-8274
(404) 768-8035
Mailing address
PO BOX 1016, SNELLVILLE, GA 30078-1016
(678) 252-2137
(678) 336-7099

Taxonomy

Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
511G701302
MEDICARE GROUP NUMBER
GA
05
910871089B
GA
Enumeration date
03/02/2009
Last updated
11/18/2011
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