Organization
PROVIDENCE RD PRIMARY CARE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
AMMA ABUNYEWA MD (PROVIDER)
(770) 973-4749
Entity
Organization
Contact information
Practice address
4180 PROVIDENCE RD, STE 105, MARIETTA, GA 30062-6186
(770) 973-4749
(770) 973-4349
Mailing address
4180 PROVIDENCE RD, STE 105, MARIETTA, GA 30062-6186
(770) 973-4749
(770) 973-4349
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
64774
GA
Other
Enumeration date
06/05/2013
Last updated
06/05/2013
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