Organization
INTERNATIONAL COMMUNITY MEDICAL NETWORK, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KWAME MAKINI (CEO)
(559) 455-3934
Entity
Organization
Contact information
Practice address
1900 WINDSOR DR SW, ATLANTA, GA 30311-4414
(559) 455-3934
Mailing address
1900 WINDSOR DR SW, ATLANTA, GA 30311-4414
(559) 455-3934
Taxonomy
Speciality
Code
Description
License number
State
2083P0901X
Public Health & General Preventive Medicine Physician
Primary
—
—
208D00000X
General Practice Physician
—
—
Other
Enumeration date
06/28/2013
Last updated
06/28/2013
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