Organization
MID PHYSICIAN NETWORK (OH), LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ADRIAN DAVIS (CHIEF EXECUTIVE OFFICER)
(678) 491-2804
Entity
Organization
Contact information
Practice address
5665 NEW NORTHSIDE DR, SUITE 520, ATLANTA, GA 30328-5831
(855) 879-4332
Mailing address
5665 NEW NORTHSIDE DR, SUITE 520, ATLANTA, GA 30328-5831
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
Primary
—
—
Other
Enumeration date
11/04/2015
Last updated
11/04/2015
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