Provider Demographics
NPI:1700108784
Name:NORTH ATLANTA MEDICAL CLINIC, L.L.C
Entity type:Organization
Organization Name:NORTH ATLANTA MEDICAL CLINIC, L.L.C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:MRS
Authorized Official - First Name:VICTORINE
Authorized Official - Middle Name:
Authorized Official - Last Name:MAFOUEKA NGUENA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:770-314-9245
Mailing Address - Street 1:2012 LITTLE RIVER DRIVE
Mailing Address - Street 2:
Mailing Address - City:SUWANEE
Mailing Address - State:GA
Mailing Address - Zip Code:30024
Mailing Address - Country:US
Mailing Address - Phone:678-380-8433
Mailing Address - Fax:678-380-8437
Practice Address - Street 1:3664 CLUB DRIVE,
Practice Address - Street 2:SUITE 201
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30044
Practice Address - Country:US
Practice Address - Phone:678-380-8433
Practice Address - Fax:678-380-8437
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-18
Last Update Date:2010-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA063092207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty