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Organization

GREATER GWINNETT PHYSICIAN PRACTICE COMPANY

Active
Other names
Mountain East Family Medicine
Organization subpart
No

Provider details

NPI number
Authorized official
CHUCK LOCKE (VP)
(800) 661-3365
Entity
Organization

Contact information

Practice address
4120 FIVE FORKS TRICKUM RD SW, SUITE 105, LILBURN, GA 30047-3130
(770) 921-6900
Mailing address
4120 FIVE FORKS TRICKUM RD SW, SUITE 105, LILBURN, GA 30047-3130
(770) 921-6900

Taxonomy

Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary

Other

Enumeration date
06/11/2006
Last updated
08/29/2007
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