Provider Demographics
NPI:1780927970
Name:PERIMETER NORTH FAMILY MEDICINE
Entity type:Organization
Organization Name:PERIMETER NORTH FAMILY MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LESLIE
Authorized Official - Middle Name:EVELYN
Authorized Official - Last Name:HEAD
Authorized Official - Suffix:
Authorized Official - Credentials:FNP-C
Authorized Official - Phone:770-664-8898
Mailing Address - Street 1:3400 OLD MILTON PKWY BLDG A
Mailing Address - Street 2:SUITE 130
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30005-3707
Mailing Address - Country:US
Mailing Address - Phone:770-664-8898
Mailing Address - Fax:770-772-4377
Practice Address - Street 1:3400 OLD MILTON PKWY BLDG A
Practice Address - Street 2:SUITE 130
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30005-3707
Practice Address - Country:US
Practice Address - Phone:770-664-8898
Practice Address - Fax:770-772-4377
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-05
Last Update Date:2013-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN149423364SF0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes364SF0001XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistFamily HealthGroup - Single Specialty