Provider Demographics
NPI:1710946371
Name:MEDICAL CENTRE OF CONYERS
Entity Type:Organization
Organization Name:MEDICAL CENTRE OF CONYERS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:F
Authorized Official - Last Name:FELTON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:770-922-9222
Mailing Address - Street 1:1445 OLD MCDONOUGH HWY SE STE E
Mailing Address - Street 2:
Mailing Address - City:CONYERS
Mailing Address - State:GA
Mailing Address - Zip Code:30094-5977
Mailing Address - Country:US
Mailing Address - Phone:770-922-9222
Mailing Address - Fax:770-922-8794
Practice Address - Street 1:1445 OLD MCDONOUGH HWY SE STE E
Practice Address - Street 2:
Practice Address - City:CONYERS
Practice Address - State:GA
Practice Address - Zip Code:30094-5977
Practice Address - Country:US
Practice Address - Phone:770-922-9222
Practice Address - Fax:770-922-8794
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-22
Last Update Date:2014-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center