Clinica Medica Familiar, LLP

Primary specialty

Obstetrics & Gynecology PhysicianTaxonomy code 207V00000X

License

014308 Issued in GA

Legal business name

CLINICA MEDICA FAMILIAR, LLP

Practice address

189 Medical Way
Suite B
Riverdale, GA 30274-4905

Phone

(770) 996-9681

Fax

(770) 996-9683

NPI assigned

May 4, 2009

Last updated

May 4, 2009By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Jack Patrick Dourron

Title

Office Manager

Phone

(770) 996-9681

Specialties & licenses 2

Addresses

Other identifiers 1

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1241395200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1241395200000",
    "number": "1619101813",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "189 MEDICAL WAY",
            "address_2": "SUITE B",
            "city": "RIVERDALE",
            "state": "GA",
            "postal_code": "302744905",
            "telephone_number": "770-996-9681",
            "fax_number": "770-996-9683"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "189 MEDICAL WAY",
            "address_2": "SUITE B",
            "city": "RIVERDALE",
            "state": "GA",
            "postal_code": "302744905",
            "telephone_number": "770-996-9681",
            "fax_number": "770-996-9683"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CLINICA MEDICA FAMILIAR, LLP",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-05-04",
        "last_updated": "2009-05-04",
        "status": "A",
        "authorized_official_last_name": "DOURRON",
        "authorized_official_first_name": "JACK",
        "authorized_official_middle_name": "PATRICK",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "770-996-9681",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "GA",
            "license": "027722",
            "primary": false
        },
        {
            "code": "207V00000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology",
            "state": "GA",
            "license": "014308",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000136958I",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Clayton Mhddad (Clayton Center CSB)
• Clayton Mhddad (Clayton CSB)
• Kathryn Rose Clayton, MD
• Clinica Familiar Y Prenatal
• Clinica Medica Dr Rene Delgado, Inc (Clinica Medica Familiar)
• Clinica Union, Inc
• Chyna Simone Cloud
• Jamyiah Laquan Coachman, CNM,WHNP-BC
• Charles Truman Colbert Jr., C.S.T./C.F.A.
• Tushanna Purdie Cole

• Obstetrics & Gynecology Physician in Riverdale, GA
• Providers in Riverdale, GA by specialty
• Obstetrics & Gynecology Physician in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 4, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.