Provider Demographics
NPI:1275733966
Name:IN AE MEDICAL CENTER PC
Entity Type:Organization
Organization Name:IN AE MEDICAL CENTER PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ESTHER
Authorized Official - Middle Name:
Authorized Official - Last Name:BRITO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:678-205-2670
Mailing Address - Street 1:2830 CLEARVIEW PL
Mailing Address - Street 2:100
Mailing Address - City:DORAVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30340-2134
Mailing Address - Country:US
Mailing Address - Phone:678-205-2670
Mailing Address - Fax:678-205-2671
Practice Address - Street 1:2830 CLEARVIEW PL
Practice Address - Street 2:100
Practice Address - City:DORAVILLE
Practice Address - State:GA
Practice Address - Zip Code:30340-2134
Practice Address - Country:US
Practice Address - Phone:678-205-2670
Practice Address - Fax:678-205-2671
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-20
Last Update Date:2007-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA054651207QG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric MedicineGroup - Multi-Specialty