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3615 Charles Hardy Pkwy Ste 200 Dallas GA 30157-9472 | |
| (770) 863-7200 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | General Practice |
| Location | 3615 Charles Hardy Pkwy Ste 200, Dallas, Georgia |
| Authorized Official Name and Position | Mark Shen (OWNER) |
| Authorized Official Contact | 5127797276 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
6910 E Chauncey Ln Ste 220 Phoenix AZ 85054-5162 Ph: (480) 247-3366 | 3615 Charles Hardy Pkwy Ste 200 Dallas GA 30157-9472 Ph: (770) 863-7200 |
| NPI Number | 1174264337 |
|---|---|
| Provider Enumeration Date | 04/04/2022 |
| Last Update Date | 10/20/2023 |
| Certification Date | 10/18/2023 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1174264337 | NPI | - | NPPES |
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