| La Vista Norcross Clinic | |
|
2625 Beaver Ruin Rd Ste B Norcross GA 30071-4136 | |
| (770) 446-2820 | |
| (770) 446-2868 |
| Full Name | La Vista Norcross Clinic |
|---|---|
| Speciality | Clinic/center - Primary Care |
| Location | 2625 Beaver Ruin Rd Ste B, Norcross, Georgia |
| Authorized Official Name and Position | Juana M Sanchez (MEDICAL DIRECTOR) |
| Authorized Official Contact | 7704462820 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| La Vista Norcross Clinic 2625 Beaver Ruin Rd Ste B Norcross GA 30071-4136 Ph: (770) 446-2820 | La Vista Norcross Clinic 2625 Beaver Ruin Rd Ste B Norcross GA 30071-4136 Ph: (770) 446-2820 |
| NPI Number | 1841571213 |
|---|---|
| Provider Enumeration Date | 08/30/2011 |
| Last Update Date | 08/30/2011 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1841571213 | NPI | - | NPPES |
| 043659295A | Medicaid | GA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | 031536 (Georgia) | Primary |
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