Provider Demographics
NPI:1174292882
Name:COMPLETE CARE FAMILY MEDICINE CLINIC LLC
Entity Type:Organization
Organization Name:COMPLETE CARE FAMILY MEDICINE CLINIC LLC
Other - Org Name:HILLSIDE FAMILY MEDICINE CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MD
Authorized Official - Prefix:DR
Authorized Official - First Name:SANDEEP
Authorized Official - Middle Name:
Authorized Official - Last Name:DHALIWAL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-485-0031
Mailing Address - Street 1:1685 MARS HILL RD NW STE 201
Mailing Address - Street 2:
Mailing Address - City:ACWORTH
Mailing Address - State:GA
Mailing Address - Zip Code:30101-7180
Mailing Address - Country:US
Mailing Address - Phone:770-485-0031
Mailing Address - Fax:678-903-4137
Practice Address - Street 1:1685 MARS HILL RD NW STE 201
Practice Address - Street 2:
Practice Address - City:ACWORTH
Practice Address - State:GA
Practice Address - Zip Code:30101-7180
Practice Address - Country:US
Practice Address - Phone:770-485-0031
Practice Address - Fax:678-903-4137
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-07
Last Update Date:2022-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty