PROVIDENCE MEDICAL GROUP, PC

ATLANTA, GA
NPI1063570604
Entity TypeOrganization
Authorized ContactOLADAYO ADISA OSINUGA
President
404-684-7111
Organization Subpart ?No
Primary Taxonomy207R00000X Internal Medicine
(Licence: GA  051703)
Enumeration Date2006-12-05
Last Update Date2012-06-19
Business Address
PROVIDENCE MEDICAL GROUP, PC
550 PEACHTREE ST NE SUITE 1285
ATLANTA, GA 30308-2249
Phone number: 404-856-3213
Mailing Address
PROVIDENCE MEDICAL GROUP, PC
PO BOX 4047
MACON, GA 31208-4047
Phone number: 404-856-3213