Providence Medical Group, Pc

NPI 1063570604 - Internal Medicine - 207R00000X

NPI Details
NPI 1063570604
Enumeration Date 12/05/2006
Last Updated 06/19/2012
Entity Type Healthcare Provider
Active Over 9 years ago
Authorized Information
Name OLADAYO ADISA OLADAYO
Position PRESIDENT
Phone (404) 856-3213
Fax (404) 856-3217
Practice Location
550 PEACHTREE ST NE
SUITE 1285
ATLANTA GA, 30308-2249, US
Phone (404) 856-3213
Fax (404) 856-3217
Business Location
PO BOX 4047
MACON GA, 31208-4047, US
Phone (404) 856-3213
Fax (404) 856-3217
Toxanomy
Taxonomy Code 207R00000X
License State Georgia
License Number 051703
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According to our database, Providence Medical Group, Pc NPI is 1063570604, taxonomy code is 207R00000X and license number is 051703, license state is located at Georgia. Providence Medical Group, Pc physically located at 550 Peachtree St Ne, Atlanta GA, 30308-2249. NPI Number 1033115704 has the healthcare provider type.

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1063570604 NPI number is provided on an as is basis without warranty of any kind. 1063570604 is maintained by the National Plan & Provider Enumeration System. The contents of Providence Medical Group, Pc are for informational purposes only.