Mini-Med Clinic Of North Georgia, LLC
Clinic/Center in Canton, GA. Organization (NPI-2).
NPI number1124792106
StatusActive
Last updated in NPPESAug 27, 2021
Details
- NPI
- 1124792106
- Entity type
- Organization (NPI-2)
- Legal business name
- Mini-Med Clinic Of North Georgia, LLC
- Organization subpart
- No
- Enumeration date
- Aug 4, 2021
- Certification date
- Aug 27, 2021
- Last updated
- Aug 27, 2021
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 261Q00000X | Clinic/Center | – | – | Yes |
Other names
- Mini-Med Clinic Of North Georgia (Doing Business As)
Practice location
5113 Holly Springs ParkwayCanton, GA 30115
Phone 470-331-3544
Mailing address
5113 Holly Springs ParkwayCanton, GA 30115
Phone 678-398-9697
Authorized official
Sophia Kennedy
Nurse Practitioner
6783989697
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