| Beyond Your Ordinary Treatment Center | |
|
97 Atlanta St Ste 100 Mcdonough GA 30253-2192 | |
| (336) 268-6469 | |
| Not Available |
| Full Name | Beyond Your Ordinary Treatment Center |
|---|---|
| Speciality | Clinic/Center |
| Location | 97 Atlanta St Ste 100, Mcdonough, Georgia |
| Authorized Official Name and Position | Mya Cullins (CEO) |
| Authorized Official Contact | 3362686469 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Beyond Your Ordinary Treatment Center 97 Atlanta St Ste 100 Mcdonough GA 30253-2192 Ph: (336) 268-6469 | Beyond Your Ordinary Treatment Center 97 Atlanta St Ste 100 Mcdonough GA 30253-2192 Ph: (336) 268-6469 |
| NPI Number | 1396365094 |
|---|---|
| Provider Enumeration Date | 04/22/2020 |
| Last Update Date | 08/12/2020 |
| Certification Date | 08/12/2020 |
| Medicare PECOS PAC ID | 6204250988 |
|---|---|
| Medicare Enrollment ID | O20200728002573 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1396365094 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Secondary |
| 261QM1300X | Clinic/center - Multi-specialty | (* (Not Available)) | Primary |
| Provider Name | Miles D Johnson |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1568419844 PECOS PAC ID: 2466437157 Enrollment ID: I20040618000358 |
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