Provider Demographics
NPI:1598269250
Name:MEDICAS MEDICAL CLINIC, LLC
Entity Type:Organization
Organization Name:MEDICAS MEDICAL CLINIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MISS
Authorized Official - First Name:SARAH
Authorized Official - Middle Name:
Authorized Official - Last Name:PRESIDENT
Authorized Official - Suffix:
Authorized Official - Credentials:FNP-C
Authorized Official - Phone:770-616-7758
Mailing Address - Street 1:PO BOX 1215
Mailing Address - Street 2:
Mailing Address - City:DOUGLASVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30133-1215
Mailing Address - Country:US
Mailing Address - Phone:770-616-7758
Mailing Address - Fax:770-489-0822
Practice Address - Street 1:1773 SWEETWATER ST
Practice Address - Street 2:
Practice Address - City:AUSTELL
Practice Address - State:GA
Practice Address - Zip Code:30106-3294
Practice Address - Country:US
Practice Address - Phone:770-575-4938
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-19
Last Update Date:2022-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN166739363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty