Provider Demographics
NPI:1891183125
Name:EXPRESS MEDICAL LLC
Entity Type:Organization
Organization Name:EXPRESS MEDICAL LLC
Other - Org Name:SYNERGY PRIMARY CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:VANESSA
Authorized Official - Middle Name:
Authorized Official - Last Name:HOWELL-PHILIP
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:770-683-4772
Mailing Address - Street 1:931 LOWER FAYETTEVILLE RD
Mailing Address - Street 2:SUITE J
Mailing Address - City:NEWNAN
Mailing Address - State:GA
Mailing Address - Zip Code:30263-5790
Mailing Address - Country:US
Mailing Address - Phone:770-683-4772
Mailing Address - Fax:770-683-4775
Practice Address - Street 1:931 LOWER FAYETTEVILLE RD
Practice Address - Street 2:SUITE J
Practice Address - City:NEWNAN
Practice Address - State:GA
Practice Address - Zip Code:30263-5790
Practice Address - Country:US
Practice Address - Phone:770-683-4772
Practice Address - Fax:770-683-4775
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-09
Last Update Date:2015-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA142462261QU0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care