| Clinica Agave Clinic | |
|
425 Sigman Road Suite #109 Conyers GA 30012 | |
| (678) 413-2026 | |
| (678) 413-2030 |
| Full Name | Clinica Agave Clinic |
|---|---|
| Speciality | Family Medicine |
| Location | 425 Sigman Road, Conyers, Georgia |
| Authorized Official Name and Position | Judith Takem Chabot (OWNER/ADMINISTRATOR) |
| Authorized Official Contact | 6784132026 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Clinica Agave Clinic 425 Sigman Road Suite #109 Conyers GA 30012 Ph: (678) 413-2026 | Clinica Agave Clinic 425 Sigman Road Suite #109 Conyers GA 30012 Ph: (678) 413-2026 |
| NPI Number | 1851496939 |
|---|---|
| Provider Enumeration Date | 09/14/2006 |
| Last Update Date | 03/23/2010 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1851496939 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
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