Dr Cory C Butzon, MD | |
1514 Vernon Rd, Lagrange, GA 30240-4131 | |
(706) 812-2369 | |
(706) 845-3194 |
Full Name | Dr Cory C Butzon |
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Gender | Male |
Speciality | Pediatrics |
Location | 1514 Vernon Rd, Lagrange, Georgia |
Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
Identifier | Type | State | Issuer |
---|---|---|---|
1659509685 | NPI | - | NPPES |
003125382A | Medicaid | GA |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
208000000X | Pediatrics | 003630 (Georgia) | Secondary |
208000000X | Pediatrics | 068124 (Georgia) | Primary |
Entity Name | Wellstar Medical Group, Llc |
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Entity Type | Part B Supplier - Clinic/group Practice |
Entity Identifiers | NPI Number: 1558664003 PECOS PAC ID: 6709065402 Enrollment ID: O20110127000374 |
Mailing Address | Practice Location Address |
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Dr Cory C Butzon, MD 1514 Vernon Rd, Lagrange, GA 30240-4131 Ph: (706) 812-2369 | Dr Cory C Butzon, MD 1514 Vernon Rd, Lagrange, GA 30240-4131 Ph: (706) 812-2369 |
Eric James Zerla, M.D. Pediatrics Medicare: Not Enrolled in Medicare Practice Location: 1550 Doctors Dr, Suite 300, Lagrange, GA 30240 Phone: 706-884-2686 Fax: 706-812-0468 | |
Kalyani Rajeev, MD Pediatrics Medicare: Medicare Enrolled Practice Location: 301 Medical Dr, Suite 504, Lagrange, GA 30240 Phone: 706-882-5437 | |
Holly Mcmahon Dawson, M.D. Pediatrics Medicare: Medicare Enrolled Practice Location: 1514 Vernon Rd, Lagrange, GA 30240 Phone: 706-812-2369 | |
Diana L Hess, CNP Pediatrics Medicare: Not Enrolled in Medicare Practice Location: 205 Calumet Center Rd, Lagrange, GA 30241 Phone: 706-885-1961 Fax: 706-885-1963 | |
Joseph Morris Almand Jr., M.D. Pediatrics Medicare: Not Enrolled in Medicare Practice Location: 1550 Doctors Dr, Suite 300, Lagrange, GA 30240 Phone: 706-884-2686 Fax: 706-812-0468 | |
George John Lechacz, M.D. Pediatrics Medicare: Not Enrolled in Medicare Practice Location: 1550 Doctors Dr, Suite 300, Lagrange, GA 30240 Phone: 706-884-2686 Fax: 706-812-0468 | |
Dr. Nicole Dupraw Carter, M.D. Pediatrics Medicare: Not Enrolled in Medicare Practice Location: 301 Medical Dr Ste 504, Lagrange, GA 30240 Phone: 706-812-2655 |