| Grassroots Medical, Grassroots Dental | |
|
4485 N Town Sq Suite 108 Powder Springs GA 30127-2242 | |
| (678) 398-6548 | |
| Not Available |
| Full Name | Grassroots Medical, Grassroots Dental |
|---|---|
| Speciality | General Practice |
| Location | 4485 N Town Sq, Powder Springs, Georgia |
| Authorized Official Name and Position | David G Aten (CHAIRMEN OF THE BOARD) |
| Authorized Official Contact | 6783986548 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Grassroots Medical, Grassroots Dental Po Box 340 Powder Springs GA 30127-0340 Ph: (678) 398-6548 | Grassroots Medical, Grassroots Dental 4485 N Town Sq Suite 108 Powder Springs GA 30127-2242 Ph: (678) 398-6548 |
| NPI Number | 1598052706 |
|---|---|
| Provider Enumeration Date | 07/08/2011 |
| Last Update Date | 06/30/2015 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1598052706 | NPI | - | NPPES |
| 003141372A | Medicaid | GA |
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