Provider Demographics
NPI:1023484417
Name:XPRESS CARE CLINIC OF GEORGIA, LLC
Entity type:Organization
Organization Name:XPRESS CARE CLINIC OF GEORGIA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:LEWIS
Authorized Official - Last Name:GRIFFIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:770-252-6500
Mailing Address - Street 1:963 BULLSBORO DR
Mailing Address - Street 2:SUITE 4D
Mailing Address - City:NEWNAN
Mailing Address - State:GA
Mailing Address - Zip Code:30265-6801
Mailing Address - Country:US
Mailing Address - Phone:770-252-6500
Mailing Address - Fax:
Practice Address - Street 1:963 BULLSBORO DR
Practice Address - Street 2:SUITE 4D
Practice Address - City:NEWNAN
Practice Address - State:GA
Practice Address - Zip Code:30265-6801
Practice Address - Country:US
Practice Address - Phone:770-252-6500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-19
Last Update Date:2016-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA027820261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care