Organization
THE BORTOLAZZO GROUP, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KIM H LARSEN (DIRECTOR OF CREDENTIALING)
(770) 874-5400
Entity
Organization
Contact information
Practice address
3950 AUSTELL RD, AUSTELL, GA 30106-1121
(770) 732-4000
Mailing address
PO BOX 22085, BELFAST, ME 04915-4117
(770) 874-5400
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
—
—
Other
Enumeration date
11/06/2006
Last updated
02/05/2020
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