Provider Demographics
NPI:1245826619
Name:MCDONOUGH WALK-IN HEALTHCARE CENTER
Entity type:Organization
Organization Name:MCDONOUGH WALK-IN HEALTHCARE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER, OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:SANDY
Authorized Official - Middle Name:T
Authorized Official - Last Name:ZACHERY
Authorized Official - Suffix:
Authorized Official - Credentials:FNP-BC
Authorized Official - Phone:678-979-7382
Mailing Address - Street 1:526 BENTLEY WAY
Mailing Address - Street 2:
Mailing Address - City:MCDONOUGH
Mailing Address - State:GA
Mailing Address - Zip Code:30253-3762
Mailing Address - Country:US
Mailing Address - Phone:678-979-7382
Mailing Address - Fax:
Practice Address - Street 1:526 BENTLEY WAY
Practice Address - Street 2:
Practice Address - City:MCDONOUGH
Practice Address - State:GA
Practice Address - Zip Code:30253-3762
Practice Address - Country:US
Practice Address - Phone:678-979-7382
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-18
Last Update Date:2023-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care