Provider Demographics
NPI:1932479722
Name:FIRST MEDICAL CLINIC
Entity Type:Organization
Organization Name:FIRST MEDICAL CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:CAN
Authorized Official - Middle Name:
Authorized Official - Last Name:JIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-457-6858
Mailing Address - Street 1:2830 CLEARVIEW PLACE
Mailing Address - Street 2:900
Mailing Address - City:DORAVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30340-2135
Mailing Address - Country:US
Mailing Address - Phone:770-457-6858
Mailing Address - Fax:770-451-8665
Practice Address - Street 1:2830 CLEARVIEW PLACE
Practice Address - Street 2:900
Practice Address - City:DORAVILLE
Practice Address - State:GA
Practice Address - Zip Code:30340-2135
Practice Address - Country:US
Practice Address - Phone:770-457-6858
Practice Address - Fax:770-451-8665
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-10
Last Update Date:2012-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty