Organization
EAST CLINIC LLC
Active
Other names
THE EAST CLINIC, LLC
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MARY J EAST M.D. (OWNER/PHYSICIAN)
(770) 505-0531
Entity
Organization
Contact information
Practice address
539 HARDEE ST, DALLAS, GA 30132-4711
(770) 505-0531
(770) 485-0570
Mailing address
539 HARDEE ST, DALLAS, GA 30132-4711
(770) 505-0531
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
63187
GA
Other
Enumeration date
11/23/2015
Last updated
12/03/2015
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