| Creative Life Center, Llc | |
|
1637 Athens Hwy Ste B Grayson GA 30017-1768 | |
| (678) 344-8269 | |
| (888) 627-6444 |
| Full Name | Creative Life Center, Llc |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 1637 Athens Hwy Ste B, Grayson, Georgia |
| Authorized Official Name and Position | Muhammad S Ahmed (CEO) |
| Authorized Official Contact | 6783448268 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Creative Life Center, Llc 1637 Athens Hwy Grayson GA 30017-1768 Ph: (678) 344-8268 | Creative Life Center, Llc 1637 Athens Hwy Ste B Grayson GA 30017-1768 Ph: (678) 344-8269 |
| NPI Number | 1780227140 |
|---|---|
| Provider Enumeration Date | 10/17/2019 |
| Last Update Date | 05/18/2021 |
| Certification Date | 05/18/2021 |
| Medicare PECOS PAC ID | 4385078823 |
|---|---|
| Medicare Enrollment ID | O20191217000059 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1780227140 | NPI | - | NPPES |
| Provider Name | Jody L Amazon |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1427038470 PECOS PAC ID: 6709887755 Enrollment ID: I20070118000361 |
| Provider Name | Muhammad S Ahmed |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1043302037 PECOS PAC ID: 2860541364 Enrollment ID: I20090512000386 |
| Provider Name | Yelta P Malone |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1306074877 PECOS PAC ID: 8426199415 Enrollment ID: I20100113000413 |
| Provider Name | Julia J Waller |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1588964795 PECOS PAC ID: 2365684925 Enrollment ID: I20130809000524 |
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