Provider Demographics
NPI:1144486283
Name:JOHNS CREEK INTERNAL MEDICINE PC
Entity type:Organization
Organization Name:JOHNS CREEK INTERNAL MEDICINE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:MAARTIN
Authorized Official - Last Name:REINGOLD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:770-476-2733
Mailing Address - Street 1:4035 JOHNS CREEK PKWY
Mailing Address - Street 2:SUITE C
Mailing Address - City:SUWANEE
Mailing Address - State:GA
Mailing Address - Zip Code:30024-1253
Mailing Address - Country:US
Mailing Address - Phone:770-476-2733
Mailing Address - Fax:770-476-1929
Practice Address - Street 1:4035 JOHNS CREEK PKWY
Practice Address - Street 2:SUITE C
Practice Address - City:SUWANEE
Practice Address - State:GA
Practice Address - Zip Code:30024-1253
Practice Address - Country:US
Practice Address - Phone:770-476-2733
Practice Address - Fax:770-476-1929
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-29
Last Update Date:2008-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care