Provider Demographics
NPI:1598075475
Name:OAKLEY FAMILY MEDICAL CLINIC LLX
Entity Type:Organization
Organization Name:OAKLEY FAMILY MEDICAL CLINIC LLX
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:B
Authorized Official - Last Name:RUY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:770-969-0004
Mailing Address - Street 1:7794 ELLA LN
Mailing Address - Street 2:STE G
Mailing Address - City:FAIRBURN
Mailing Address - State:GA
Mailing Address - Zip Code:30213-5511
Mailing Address - Country:US
Mailing Address - Phone:770-969-0004
Mailing Address - Fax:
Practice Address - Street 1:7794 ELLA LN
Practice Address - Street 2:STE G
Practice Address - City:FAIRBURN
Practice Address - State:GA
Practice Address - Zip Code:30213-5511
Practice Address - Country:US
Practice Address - Phone:770-969-0004
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-13
Last Update Date:2010-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA032649261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center