Provider Demographics
NPI:1578955795
Name:PHYSICIAN'S EXPRESS CARE AT CREEKSTONE
Entity Type:Organization
Organization Name:PHYSICIAN'S EXPRESS CARE AT CREEKSTONE
Other - Org Name:PHYSICIAN'S EXPRESS CARE AT CREEKSTONE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:G
Authorized Official - Last Name:DUKES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:770-772-1830
Mailing Address - Street 1:1780 PEACHTREE PKWY STE 3302
Mailing Address - Street 2:
Mailing Address - City:CUMMING
Mailing Address - State:GA
Mailing Address - Zip Code:30041-6834
Mailing Address - Country:US
Mailing Address - Phone:770-772-1830
Mailing Address - Fax:470-239-7296
Practice Address - Street 1:1780 PEACHTREE PKWY STE 302
Practice Address - Street 2:
Practice Address - City:CUMMING
Practice Address - State:GA
Practice Address - Zip Code:30041-6834
Practice Address - Country:US
Practice Address - Phone:770-772-1830
Practice Address - Fax:470-239-7296
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PHYSICIANS EXPRESS CARE LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-02-25
Last Update Date:2021-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA51875261QU0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care