Organization
MACAGAIN
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KHALID ANSARI (PRESIDENT)
(678) 386-1625
Entity
Organization
Contact information
Practice address
3650 SAVANNAH PL, DULUTH, GA 30096-4898
(206) 866-7605
Mailing address
3650 SAVANNAH PL, DULUTH, GA 30096-4898
(678) 386-1625
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
—
—
246RP1900X
Phlebotomy Technician
—
—
291U00000X
Clinical Medical Laboratory
Primary
—
—
Other
Enumeration date
10/18/2021
Last updated
03/30/2023
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