| |
2855 Lawrenceville Suwanee Rd Ste 330 Suwanee GA 30024-3572 | |
(800) 805-6989 | |
(864) 558-8511 |
Full Name | |
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Speciality | Clinic/Center |
Location | 2855 Lawrenceville Suwanee Rd Ste 330, Suwanee, Georgia |
Authorized Official Name and Position | Rupert James Mccormac (PRESIDENT) |
Authorized Official Contact | 8008056989 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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200 E Broad St Ste 300 Greenville SC 29601-2891 Ph: (800) 805-6989 | 2855 Lawrenceville Suwanee Rd Ste 330 Suwanee GA 30024-3572 Ph: (800) 805-6989 |
NPI Number | 1518484476 |
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Provider Enumeration Date | 08/23/2017 |
Last Update Date | 06/08/2022 |
Certification Date | 06/08/2022 |
Medicare PECOS PAC ID | 5597193490 |
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Medicare Enrollment ID | O20200306001010 |
Identifier | Type | State | Issuer |
---|---|---|---|
1518484476 | NPI | - | NPPES |
NTP001068 | Other | GA | STATE LICENSE |
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