Covenant Family Medicine
Family Medicine in Dacula, GA. Organization (NPI-2).
NPI number1962532085
StatusActive
Last updated in NPPESJan 15, 2010
Details
- NPI
- 1962532085
- Entity type
- Organization (NPI-2)
- Legal business name
- Covenant Family Medicine
- Organization subpart
- No
- Enumeration date
- Mar 7, 2007
- Last updated
- Jan 15, 2010
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 207Q00000X | Family Medicine | – | – | Yes |
Practice location
2098 Teron Trace Suite 150Dacula, GA 30019
Phone 678-730-1620 · Fax 678-730-0858
Mailing address
2098 Teron Trace Suite 150Dacula, GA 30019
Phone 678-730-1620 · Fax 678-730-0858
Authorized official
Henry Song Moon
Partner
6787301620
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