Jose R Villongco, Md | |
2406 Macy Dr Roswell GA 30076-6343 | |
(770) 331-0812 | |
(770) 910-9040 |
Full Name | Jose R Villongco, Md |
---|---|
Speciality | Psychiatry & Neurology |
Location | 2406 Macy Dr, Roswell, Georgia |
Authorized Official Name and Position | Jose R Villongco (CEO) |
Authorized Official Contact | 7703310812 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
---|---|
Jose R Villongco, Md 2406 Macy Dr Roswell GA 30076-6343 Ph: (770) 331-0812 | Jose R Villongco, Md 2406 Macy Dr Roswell GA 30076-6343 Ph: (770) 331-0812 |
NPI Number | 1467901124 |
---|---|
Provider Enumeration Date | 09/22/2016 |
Last Update Date | 04/17/2017 |
Medicare PECOS PAC ID | 3971889403 |
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Medicare Enrollment ID | O20170417000788 |
Identifier | Type | State | Issuer |
---|---|---|---|
1467901124 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
2084P0800X | Psychiatry & Neurology - Psychiatry | 042479 (Georgia) | Primary |
Provider Name | Jose R Villongco |
---|---|
Provider Type | Practitioner - Psychiatry |
Provider Identifiers | NPI Number: 1942272729 PECOS PAC ID: 1153594924 Enrollment ID: I20111024000599 |
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