Provider Demographics
NPI:1598427130
Name:CENTRO DE SALUD FAMILIAR NORCROSS MEDICAL CLINIC LLC
Entity type:Organization
Organization Name:CENTRO DE SALUD FAMILIAR NORCROSS MEDICAL CLINIC LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER, CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:RODRIGO
Authorized Official - Middle Name:
Authorized Official - Last Name:PARRA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-333-3498
Mailing Address - Street 1:5717 ALLEE WAY
Mailing Address - Street 2:
Mailing Address - City:BRASELTON
Mailing Address - State:GA
Mailing Address - Zip Code:30517-6200
Mailing Address - Country:US
Mailing Address - Phone:678-333-3498
Mailing Address - Fax:
Practice Address - Street 1:5836 BUFORD HWY STE C
Practice Address - Street 2:
Practice Address - City:NORCROSS
Practice Address - State:GA
Practice Address - Zip Code:30071-2581
Practice Address - Country:US
Practice Address - Phone:770-734-9920
Practice Address - Fax:770-734-9115
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-11
Last Update Date:2025-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP0904XAmbulatory Health Care FacilitiesClinic/CenterPublic Health, Federal