| Mjra Medical Llc | |
|
3675 J Dewey Gray Cr Ste 300 Augusta GA 30909 | |
| (706) 869-0501 | |
| (706) 447-7111 |
| Full Name | Mjra Medical Llc |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 3675 J Dewey Gray Cr Ste 300, Augusta, Georgia |
| Authorized Official Name and Position | Maria J Rivell (OWNER) |
| Authorized Official Contact | 7068690501 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Mjra Medical Llc 3675 J Dewey Gray Cr Ste 300 Augusta GA 30909 Ph: (706) 869-0501 | Mjra Medical Llc 3675 J Dewey Gray Cr Ste 300 Augusta GA 30909 Ph: (706) 869-0501 |
| NPI Number | 1598397838 |
|---|---|
| Provider Enumeration Date | 02/05/2020 |
| Last Update Date | 02/05/2020 |
| Certification Date | 02/05/2020 |
| Medicare PECOS PAC ID | 8820409816 |
|---|---|
| Medicare Enrollment ID | O20201123003115 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1598397838 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TC0700X | Psychologist - Clinical | (* (Not Available)) | Secondary |
| 2084P0800X | Psychiatry & Neurology - Psychiatry | (* (Not Available)) | Primary |
| Provider Name | Maria J Rivell |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1508975368 PECOS PAC ID: 8628103355 Enrollment ID: I20100318000904 |
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