Organization
CLINICA AGAVE CLINIC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JUDITH TAKEM CHABOT FNP-C (OWNER/ADMINISTRATOR)
(678) 413-2026
Entity
Organization
Contact information
Practice address
425 SIGMAN ROAD, SUITE #109, CONYERS, GA 30012
(678) 413-2026
(678) 413-2030
Mailing address
425 SIGMAN ROAD, SUITE #109, CONYERS, GA 30012
(678) 413-2026
(678) 413-2030
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Enumeration date
09/14/2006
Last updated
03/23/2010
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