| Idlewood Medical Clinic Inc | |
|
2157 Idlewood Rd Ste B Tucker GA 30084-4832 | |
| (305) 388-4383 | |
| (305) 388-4380 |
| Full Name | Idlewood Medical Clinic Inc |
|---|---|
| Speciality | Family Medicine - Adult Medicine |
| Location | 2157 Idlewood Rd, Tucker, Georgia |
| Authorized Official Name and Position | Aida Rosa De La Vega (CEO) |
| Authorized Official Contact | 3053884383 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Idlewood Medical Clinic Inc 2157 Idlewood Rd Ste B Tucker GA 30084-4832 Ph: (305) 388-4383 | Idlewood Medical Clinic Inc 2157 Idlewood Rd Ste B Tucker GA 30084-4832 Ph: (305) 388-4383 |
| NPI Number | 1316249246 |
|---|---|
| Provider Enumeration Date | 11/29/2010 |
| Last Update Date | 12/17/2010 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1316249246 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207QA0505X | Family Medicine - Adult Medicine | (* (Not Available)) | Primary |
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