| Kboggspc | |
|
5435 Sugarloaf Pkwy Suite 1104 Lawrenceville GA 30043 | |
| (678) 358-6200 | |
| Not Available |
| Full Name | Kboggspc |
|---|---|
| Speciality | Social Worker |
| Location | 5435 Sugarloaf Pkwy, Lawrenceville, Georgia |
| Authorized Official Name and Position | Katherine Boggs (PRESIDENT) |
| Authorized Official Contact | 6783586200 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Kboggspc 4602 Sequoia Cir Oakwood GA 30566-2129 Ph: (678) 358-6200 | Kboggspc 5435 Sugarloaf Pkwy Suite 1104 Lawrenceville GA 30043 Ph: (678) 358-6200 |
| NPI Number | 1386085280 |
|---|---|
| Provider Enumeration Date | 07/09/2013 |
| Last Update Date | 07/09/2013 |
| Medicare PECOS PAC ID | 4183865835 |
|---|---|
| Medicare Enrollment ID | O20130723000974 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1386085280 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | CSW001288 (Georgia) | Primary |
| Provider Name | Katherine H Boggs |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1033276613 PECOS PAC ID: 7315188414 Enrollment ID: I20130801000661 |
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