Provider Demographics
NPI:1558916056
Name:NEWTOWN PARK MEDICAL CLINIC AND GERIATRICS LLC
Entity Type:Organization
Organization Name:NEWTOWN PARK MEDICAL CLINIC AND GERIATRICS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ORGANIZER
Authorized Official - Prefix:
Authorized Official - First Name:SUDHA
Authorized Official - Middle Name:
Authorized Official - Last Name:CHALLA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:678-545-5080
Mailing Address - Street 1:2880 OLD ALABAMA RD #300
Mailing Address - Street 2:
Mailing Address - City:JOHNS CREEK
Mailing Address - State:GA
Mailing Address - Zip Code:30022-5033
Mailing Address - Country:US
Mailing Address - Phone:470-299-3991
Mailing Address - Fax:470-299-3998
Practice Address - Street 1:2880 OLD ALABAMA RD #300
Practice Address - Street 2:
Practice Address - City:JOHNS CREEK
Practice Address - State:GA
Practice Address - Zip Code:30022-5033
Practice Address - Country:US
Practice Address - Phone:470-299-3991
Practice Address - Fax:470-299-3998
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-02
Last Update Date:2019-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric MedicineGroup - Single Specialty