| R Michael Prudent Llc | |
|
675 Seminole Ave Ne Suite 305 Atlanta GA 30307-3408 | |
| (404) 685-3113 | |
| (404) 601-4494 |
| Full Name | R Michael Prudent Llc |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 675 Seminole Ave Ne, Atlanta, Georgia |
| Authorized Official Name and Position | Robert Michael Prudent (OWNER) |
| Authorized Official Contact | 4046853113 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| R Michael Prudent Llc 675 Seminole Ave Ne Suite 305 Atlanta GA 30307-3408 Ph: (404) 685-3113 | R Michael Prudent Llc 675 Seminole Ave Ne Suite 305 Atlanta GA 30307-3408 Ph: (404) 685-3113 |
| NPI Number | 1720318306 |
|---|---|
| Provider Enumeration Date | 01/05/2010 |
| Last Update Date | 01/05/2010 |
| Medicare PECOS PAC ID | 8628110574 |
|---|---|
| Medicare Enrollment ID | O20100115000310 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1720318306 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084P0800X | Psychiatry & Neurology - Psychiatry | 037340 (Georgia) | Primary |
| Provider Name | Robert M Prudent |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1366587479 PECOS PAC ID: 8022090802 Enrollment ID: I20040604000423 |
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