Illuminate Medical LLC
General Practice in Flowery Branch, GA. Organization (NPI-2).
NPI number1831928126
StatusActive
Last updated in NPPESJul 26, 2024
Details
- NPI
- 1831928126
- Entity type
- Organization (NPI-2)
- Legal business name
- Illuminate Medical LLC
- Organization subpart
- No
- Enumeration date
- Jul 26, 2024
- Certification date
- Jul 26, 2024
- Last updated
- Jul 26, 2024
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 208D00000X | General Practice | – | – | Yes |
Practice location
5257 Bowman Springs TrlFlowery Branch, GA 30542-5193
Phone 470-846-3790
Mailing address
5257 Bowman Springs TrlFlowery Branch, GA 30542-5193
Phone 470-846-3790
Authorized official
Seth M Illu
President
4708463790
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