Organization
COMMONWEALTH PRIMARY CARE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JAYASRI MALLAVARAPU MD, MPH (CEO)
(678) 455-2295
Entity
Organization
Contact information
Practice address
1614 PEACHTREE PKWY, SUITE # 200, CUMMING, GA 30041-6883
(678) 455-2295
(678) 455-2279
Mailing address
1614 PEACHTREE PKWY, SUITE # 200, CUMMING, GA 30041-6883
(678) 455-2295
(678) 455-2279
Taxonomy
Speciality
Code
Description
License number
State
261QP2300X
Primary Care Clinic/Center
Primary
061288
GA
Other
Enumeration date
11/05/2013
Last updated
03/25/2014
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