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1568 Southlake Pkwy Ste C, Morrow, GA 30260 | |
(470) 878-0696 | |
Not Available |
Full Name | |
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Type | Facility |
Speciality | Clinic/center - Multi-specialty |
Location | 1568 Southlake Pkwy Ste C, Morrow, Georgia |
Accepts Medicare Assignments | Medicare enrolled and accepts medicare insurance. Providers at this facility may prescribe medicare part D drugs. |
Identifier | Type | State | Issuer |
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1043679418 | NPI | - | NPPES |
Provider Name | Cornell Peters |
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Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1861487225 PECOS PAC ID: 1557492758 Enrollment ID: I20100702000437 |
Provider Name | Victor Osisanya |
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Provider Type | Practitioner - Pain Management |
Provider Identifiers | NPI Number: 1679884753 PECOS PAC ID: 8628393451 Enrollment ID: I20150218002209 |
Provider Name | Sheimeita Chance |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1144692500 PECOS PAC ID: 5092012880 Enrollment ID: I20160322001125 |
Provider Name | Vandy Gaffney |
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Provider Type | Practitioner - Anesthesiology |
Provider Identifiers | NPI Number: 1730470329 PECOS PAC ID: 3274776869 Enrollment ID: I20170509001065 |
Provider Name | Anslie Prudhomme |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1285126391 PECOS PAC ID: 9234574641 Enrollment ID: I20240226001094 |
Mailing Address | Practice Location Address |
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1568 Southlake Pkwy Ste C, Morrow, GA 30260-4153 Ph: (470) 878-0696 | 1568 Southlake Pkwy Ste C, Morrow, GA 30260 Ph: (470) 878-0696 |