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900 Old Roswell Lakes Pkwy Ste 310 Roswell GA 30076-8667 | |
| (919) 932-0928 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Family Medicine |
| Location | 900 Old Roswell Lakes Pkwy Ste 310, Roswell, Georgia |
| Authorized Official Name and Position | Ronald Michael Creatore (CFO/GENERAL COUNSEL) |
| Authorized Official Contact | 9199320928 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
510 Meadowmont Village Cir Ste 323 Chapel Hill NC 27517-7584 Ph: (919) 932-0928 | 900 Old Roswell Lakes Pkwy Ste 310 Roswell GA 30076-8667 Ph: (919) 932-0928 |
| NPI Number | 1962014118 |
|---|---|
| Provider Enumeration Date | 08/19/2020 |
| Last Update Date | 08/26/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1962014118 | NPI | - | NPPES |
| 20140276 | Other | GA | GEORGIA SECRETARY OF STATE |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
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