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2488 Scenic Hwy S Snellville GA 30078-5710 | |
| (770) 289-7150 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Clinic/center |
| Location | 2488 Scenic Hwy S, Snellville, Georgia |
| Authorized Official Name and Position | Sunday Alaba Fawole (MEDICAL DIRECTOR) |
| Authorized Official Contact | 7702897150 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
801 Berryman Pl Lawrenceville GA 30045-8297 Ph: (770) 289-7150 | 2488 Scenic Hwy S Snellville GA 30078-5710 Ph: (770) 289-7150 |
| NPI Number | 1457787350 |
|---|---|
| Provider Enumeration Date | 09/24/2013 |
| Last Update Date | 09/24/2013 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1457787350 | NPI | - | NPPES |
| 1164591913 | Other | GA | NPI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | 55514 (Georgia) | Primary |
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