National Provider Identifier Database

EAGLE DRIVE FAMILY MEDICINE PC
General Practice

A physician who specializes in the general practice of diagnosing, treating, and managing patients with a variety of illnesses and conditions.


Contact Information

EAGLE DRIVE FAMILY MEDICINE PC
1816 EAGLE DR
SUITE 200-B
WOODSTOCK, GA30189-8272
Phone: 678-445-5995
Fax:
Website:
Specialty Taxonomy Code
* General Practice 208D00000X

* Indicates primary specialty

NPI Profile & details for EAGLE DRIVE FAMILY MEDICINE PC

NPI Number 1750514295
Legal business name
LBN
EAGLE DRIVE FAMILY MEDICINE PC
Authorized official RICHARD MANRIQUE - (PRESIDENT)
Entity Organization
Organization subpart No
Enumeration date 09/01/2009
Last updated 01/25/2012 - About 14 years ago
Sole proprietor1 Not specified
Identifiers n/a

1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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