| |
777 Cleveland Ave Sw Ste 500, Atlanta, GA 30315-7115 | |
(404) 755-2291 | |
(404) 755-5377 |
Full Name | |
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Type | Facility |
Speciality | Family Medicine |
Location | 777 Cleveland Ave Sw Ste 500, Atlanta, Georgia |
Accepts Medicare Assignments | Medicare enrolled and accepts medicare insurance. Providers at this facility may prescribe medicare part D drugs. |
Identifier | Type | State | Issuer |
---|---|---|---|
1376952069 | NPI | - | NPPES |
003188149A | Medicaid | GA |
Provider Name | Otis S Powell |
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Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1285654301 PECOS PAC ID: 6103804554 Enrollment ID: I20040713000109 |
Provider Name | Jimmy L Gregory |
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Provider Type | Practitioner - Podiatry |
Provider Identifiers | NPI Number: 1073574083 PECOS PAC ID: 0446238729 Enrollment ID: I20040713000131 |
Provider Name | Herretta Pickens |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1982988028 PECOS PAC ID: 8527224617 Enrollment ID: I20120717000546 |
Mailing Address | Practice Location Address |
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777 Cleveland Ave Sw Ste 500, Atlanta, GA 30315-7115 Ph: (404) 755-2291 | 777 Cleveland Ave Sw Ste 500, Atlanta, GA 30315-7115 Ph: (404) 755-2291 |