Organization
EAGLE DRIVE FAMILY MEDICINE PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RICHARD LEON MANRIQUE M.D. (PRESIDENT)
(678) 445-5995
Entity
Organization
Contact information
Practice address
1816 EAGLE DR, SUITE 200-B, WOODSTOCK, GA 30189-8272
(678) 445-5995
Mailing address
1816 EAGLE DR, SUITE 200-B, WOODSTOCK, GA 30189-8272
(678) 445-5995
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
Primary
—
—
Other
Enumeration date
09/01/2009
Last updated
01/25/2012
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