Provider Demographics
NPI:1699904219
Name:PHYSICIANS IMMEDIATE MED OF JOHNS CREEK PC
Entity type:Organization
Organization Name:PHYSICIANS IMMEDIATE MED OF JOHNS CREEK PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO, PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:A
Authorized Official - Last Name:YOST
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:770-888-8777
Mailing Address - Street 1:2575 PEACHTREE PKWY
Mailing Address - Street 2:SUITE 100
Mailing Address - City:CUMMING
Mailing Address - State:GA
Mailing Address - Zip Code:30041-7559
Mailing Address - Country:US
Mailing Address - Phone:770-888-8777
Mailing Address - Fax:770-888-8779
Practice Address - Street 1:2575 PEACHTREE PKWY
Practice Address - Street 2:SUITE 100
Practice Address - City:CUMMING
Practice Address - State:GA
Practice Address - Zip Code:30041-7559
Practice Address - Country:US
Practice Address - Phone:770-888-8777
Practice Address - Fax:770-888-8779
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-02
Last Update Date:2013-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
No207PE0005XAllopathic & Osteopathic PhysiciansEmergency MedicineUndersea and Hyperbaric MedicineGroup - Multi-Specialty
No261QP3300XAmbulatory Health Care FacilitiesClinic/CenterPain