Provider Demographics
NPI:1104221514
Name:DULUTH MEDICAL CENTER, LLC
Entity Type:Organization
Organization Name:DULUTH MEDICAL CENTER, LLC
Other - Org Name:SUGARHILL MEDICAL AND SPINE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:GENERAL MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:EDDY
Authorized Official - Middle Name:
Authorized Official - Last Name:LAJARA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-831-9202
Mailing Address - Street 1:1400 BUFORD HWY
Mailing Address - Street 2:BUILDING R-1
Mailing Address - City:BUFORD
Mailing Address - State:GA
Mailing Address - Zip Code:30518-8721
Mailing Address - Country:US
Mailing Address - Phone:770-831-9202
Mailing Address - Fax:678-730-7777
Practice Address - Street 1:1400 BUFORD HWY
Practice Address - Street 2:BUILDING R-1
Practice Address - City:BUFORD
Practice Address - State:GA
Practice Address - Zip Code:30518-8721
Practice Address - Country:US
Practice Address - Phone:770-831-9202
Practice Address - Fax:678-730-7777
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-28
Last Update Date:2014-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR008572111N00000X
GA38981207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty