Organization · NPI-2

Downtown Medical Clinic, LLC

Family Medicine · Dublin, GA

NPI number1376237354

StatusActive

Last updated in NPPESJul 9, 2024

Details

NPI: 1376237354
Entity type: Organization (NPI-2)
Legal business name: Downtown Medical Clinic, LLC
Organization subpart: No
Enumeration date: Jun 5, 2023
Certification date: Jul 9, 2024
Last updated: Jul 9, 2024

Taxonomy and licenses

Taxonomy code	Description	License	State	Primary
207Q00000X	Family Medicine	–	–	Yes
208VP0000X		–	–
261Q00000X	Clinic/Center	–	–
261QH0100X	Clinic/Center, Health Services	–	–

Other names

Glam Town Medical & Spa LLC (Former Legal Business Name)

Practice location

124 W Madison St Ste D
Dublin, GA 31021-5180

Phone 478-304-0606 · Fax 888-375-3879

Mailing address

124 W Madison St Ste D
Dublin, GA 31021-5180

Phone 478-304-0606 · Fax 888-375-3879

Authorized official

Ronda Joy Cochran
Administrator
4783040606

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