| Beltline Bariatric And Surgical Group Llc | |
|
371 E Paces Ferry Rd Ne Ste 750 Atlanta GA 30305-2372 | |
| (470) 419-4380 | |
| (470) 298-7736 |
| Full Name | Beltline Bariatric And Surgical Group Llc |
|---|---|
| Speciality | Surgery |
| Location | 371 E Paces Ferry Rd Ne Ste 750, Atlanta, Georgia |
| Authorized Official Name and Position | Diana Kapou Wong (COO) |
| Authorized Official Contact | 7706861366 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Beltline Bariatric And Surgical Group Llc 371 E Paces Ferry Rd Ne Ste 750 Atlanta GA 30305-2372 Ph: (470) 419-4380 | Beltline Bariatric And Surgical Group Llc 371 E Paces Ferry Rd Ne Ste 750 Atlanta GA 30305-2372 Ph: (470) 419-4380 |
| NPI Number | 1700232865 |
|---|---|
| Provider Enumeration Date | 05/09/2016 |
| Last Update Date | 11/01/2023 |
| Certification Date | 07/25/2022 |
| Medicare PECOS PAC ID | 6204114929 |
|---|---|
| Medicare Enrollment ID | O20161101001707 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1700232865 | NPI | - | NPPES |
| Provider Name | Charles Daniel Procter |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1598780488 PECOS PAC ID: 5496855587 Enrollment ID: I20070702000401 |
| Provider Name | Jennifer M Robinson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1790072601 PECOS PAC ID: 8921277344 Enrollment ID: I20110801000611 |
| Provider Name | Michelle L Ledford |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1245710144 PECOS PAC ID: 7517294481 Enrollment ID: I20190815000709 |
| Provider Name | Roger Francis Eduardo |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1962792366 PECOS PAC ID: 4981997400 Enrollment ID: I20200406003193 |
| Provider Name | Vishwanath Raju Danthuluri |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1699118844 PECOS PAC ID: 5799089314 Enrollment ID: I20220126001518 |
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