Provider Demographics
NPI:1902230329
Name:PHYSICIAN'S EXPRESS CARE AT TOWNE LAKE LLC
Entity Type:Organization
Organization Name:PHYSICIAN'S EXPRESS CARE AT TOWNE LAKE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:G
Authorized Official - Last Name:DUKES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:770-772-1830
Mailing Address - Street 1:1780 PEACHTREE PKWY STE 302
Mailing Address - Street 2:
Mailing Address - City:CUMMING
Mailing Address - State:GA
Mailing Address - Zip Code:30041-6834
Mailing Address - Country:US
Mailing Address - Phone:770-772-1830
Mailing Address - Fax:470-253-8215
Practice Address - Street 1:900 TOWNE LAKE PKWY STE 104
Practice Address - Street 2:
Practice Address - City:WOODSTOCK
Practice Address - State:GA
Practice Address - Zip Code:30189-1603
Practice Address - Country:US
Practice Address - Phone:770-772-1830
Practice Address - Fax:770-693-5902
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-22
Last Update Date:2021-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA51875174400000X, 261QU0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
No174400000XOther Service ProvidersSpecialistGroup - Single Specialty