Provider Demographics
NPI:1477158541
Name:A PLUS CLINIC
Entity Type:Organization
Organization Name:A PLUS CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MALI
Authorized Official - Middle Name:
Authorized Official - Last Name:KHAMISSI-SOBI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-875-6870
Mailing Address - Street 1:4787 AUSTELL RD
Mailing Address - Street 2:
Mailing Address - City:AUSTELL
Mailing Address - State:GA
Mailing Address - Zip Code:30106-2001
Mailing Address - Country:US
Mailing Address - Phone:770-875-6870
Mailing Address - Fax:
Practice Address - Street 1:4787 AUSTELL RD
Practice Address - Street 2:
Practice Address - City:AUSTELL
Practice Address - State:GA
Practice Address - Zip Code:30106-2001
Practice Address - Country:US
Practice Address - Phone:770-875-6870
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-04
Last Update Date:2021-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty