Organization
SOUTH FORSYTH FAMILY MEDICINE AND PEDIATRICS LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. DINA J GORE (MEDICAL BILLING & INSURANCE MANAGER)
(770) 343-9112
Entity
Organization
Contact information
Practice address
1845 LOCKEWAY DR, SUITE 404, ALPHARETTA, GA 30004-5936
(770) 343-9112
(770) 343-8911
Mailing address
1845 LOCKEWAY DR, SUITE 404, ALPHARETTA, GA 30004-5936
(770) 343-9112
(770) 343-8911
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
2401782
GA
208000000X
Pediatrics Physician
2401782
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000630759E
—
GA
05
—
000630759F
—
GA
Enumeration date
10/09/2007
Last updated
01/17/2013
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