Provider Demographics
NPI:1679755029
Name:INTERNAL MEDICINE SPECIALISTS
Entity Type:Organization
Organization Name:INTERNAL MEDICINE SPECIALISTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DORA
Authorized Official - Middle Name:
Authorized Official - Last Name:CAULFIELD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-709-0900
Mailing Address - Street 1:721 WELLNESS WAY
Mailing Address - Street 2:SUITE 100
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30045-3304
Mailing Address - Country:US
Mailing Address - Phone:770-709-0900
Mailing Address - Fax:
Practice Address - Street 1:721 WELLNESS WAY
Practice Address - Street 2:SUITE 100
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30045-3304
Practice Address - Country:US
Practice Address - Phone:770-709-0900
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-28
Last Update Date:2007-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA034236207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAF03569Medicare UPIN