Provider Demographics
NPI:1366689473
Name:NORTH FULTON PRIMARY CARE - WINDWARD PARKWAY, LLC
Entity Type:Organization
Organization Name:NORTH FULTON PRIMARY CARE - WINDWARD PARKWAY, LLC
Other - Org Name:NORTH FULTON PRIMARY CARE - WINDWARD PARKWAY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:REGIONAL CFO, TENET
Authorized Official - Prefix:MR
Authorized Official - First Name:WESLEY
Authorized Official - Middle Name:O
Authorized Official - Last Name:JAMES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-265-5009
Mailing Address - Street 1:PO BOX 741650
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30384-1650
Mailing Address - Country:US
Mailing Address - Phone:770-475-0888
Mailing Address - Fax:770-475-3025
Practice Address - Street 1:4895 WINDWARD PKWY
Practice Address - Street 2:SUITE 202
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30004-3850
Practice Address - Country:US
Practice Address - Phone:770-475-0888
Practice Address - Fax:770-475-3025
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-12
Last Update Date:2016-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003109454AMedicaid
202G706257Medicare PIN