| Clinica Medica Familiar, Llp | |
|
189 Medical Way Suite B Riverdale GA 30274-4905 | |
| (770) 996-9681 | |
| (770) 996-9683 |
| Full Name | Clinica Medica Familiar, Llp |
|---|---|
| Speciality | Obstetrics & Gynecology |
| Location | 189 Medical Way, Riverdale, Georgia |
| Authorized Official Name and Position | Jack Patrick Dourron (OFFICE MANAGER) |
| Authorized Official Contact | 7709969681 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Clinica Medica Familiar, Llp 189 Medical Way Suite B Riverdale GA 30274-4905 Ph: (770) 996-9681 | Clinica Medica Familiar, Llp 189 Medical Way Suite B Riverdale GA 30274-4905 Ph: (770) 996-9681 |
| NPI Number | 1619101813 |
|---|---|
| Provider Enumeration Date | 05/04/2009 |
| Last Update Date | 05/04/2009 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1619101813 | NPI | - | NPPES |
| 000136958I | Medicaid | GA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | 027722 (Georgia) | Secondary |
| 207V00000X | Obstetrics & Gynecology | 014308 (Georgia) | Primary |
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