| Geode Health Of Georgia Llc | |
|
227 Scenic Hwy Ste A Lawrenceville GA 30046-5649 | |
| (630) 912-4241 | |
| Not Available |
| Full Name | Geode Health Of Georgia Llc |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 227 Scenic Hwy Ste A, Lawrenceville, Georgia |
| Authorized Official Name and Position | Brandy L Marriner (CREDENTIALING MANAGER) |
| Authorized Official Contact | 6309124241 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Geode Health Of Georgia Llc 1211 W 22nd St Ste 406 Oak Brook IL 60523-2169 Ph: (888) 902-1704 | Geode Health Of Georgia Llc 227 Scenic Hwy Ste A Lawrenceville GA 30046-5649 Ph: (630) 912-4241 |
| NPI Number | 1477265718 |
|---|---|
| Provider Enumeration Date | 12/19/2022 |
| Last Update Date | 11/07/2024 |
| Certification Date | 11/07/2024 |
| Medicare PECOS PAC ID | 4880066059 |
|---|---|
| Medicare Enrollment ID | O20230216001357 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1477265718 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084P0800X | Psychiatry & Neurology - Psychiatry | (* (Not Available)) | Primary |
| Provider Name | Mahendra R Shah |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1326122367 PECOS PAC ID: 0840375721 Enrollment ID: I20101115001043 |
| Provider Name | Shripal K Makim |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1104900141 PECOS PAC ID: 1658566740 Enrollment ID: I20101115001075 |
| Provider Name | Kimberly C Drummond |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1043970650 PECOS PAC ID: 0244610939 Enrollment ID: I20220712002833 |
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