Provider Demographics
NPI:1336490010
Name:MEDICLINIC OF GEORGIA P.C
Entity Type:Organization
Organization Name:MEDICLINIC OF GEORGIA P.C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ELVIRA
Authorized Official - Middle Name:MARGARITA
Authorized Official - Last Name:GARCIA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:404-395-6644
Mailing Address - Street 1:7887 ROSWELL RD STE B
Mailing Address - Street 2:
Mailing Address - City:SANDY SPRINGS
Mailing Address - State:GA
Mailing Address - Zip Code:30350-4829
Mailing Address - Country:US
Mailing Address - Phone:404-635-6644
Mailing Address - Fax:
Practice Address - Street 1:7887 ROSWELL RD STE B
Practice Address - Street 2:
Practice Address - City:SANDY SPRINGS
Practice Address - State:GA
Practice Address - Zip Code:30350-4829
Practice Address - Country:US
Practice Address - Phone:404-635-6644
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-21
Last Update Date:2012-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FM068412261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care