Provider Demographics
NPI:1033493820
Name:EAST POINT PHYSICIANS GROUP, PC
Entity Type:Organization
Organization Name:EAST POINT PHYSICIANS GROUP, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:ADETOKUNBOH
Authorized Official - Middle Name:MONSUREEN
Authorized Official - Last Name:ADEBAYO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:404-855-2730
Mailing Address - Street 1:1203 CLEVELAND AVE
Mailing Address - Street 2:SUITE 1-C
Mailing Address - City:EAST POINT
Mailing Address - State:GA
Mailing Address - Zip Code:30344-3417
Mailing Address - Country:US
Mailing Address - Phone:404-855-2730
Mailing Address - Fax:
Practice Address - Street 1:1203 CLEVELAND AVE
Practice Address - Street 2:SUITE 1-C
Practice Address - City:EAST POINT
Practice Address - State:GA
Practice Address - Zip Code:30344-3417
Practice Address - Country:US
Practice Address - Phone:404-855-2730
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-28
Last Update Date:2011-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty