| Fidelity Health Care Group, Llc | |
|
950 Eagles Landing Pkwy # 152 Stockbridge GA 30281-7343 | |
| (703) 929-8967 | |
| (404) 601-8328 |
| Full Name | Fidelity Health Care Group, Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 950 Eagles Landing Pkwy, Stockbridge, Georgia |
| Authorized Official Name and Position | John A Glenn (MEDICAL DIRECTOR) |
| Authorized Official Contact | 4782908509 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Fidelity Health Care Group, Llc 950 Eagles Landing Pkwy # 152 Stockbridge GA 30281-7343 Ph: (703) 929-8967 | Fidelity Health Care Group, Llc 950 Eagles Landing Pkwy # 152 Stockbridge GA 30281-7343 Ph: (703) 929-8967 |
| NPI Number | 1174905830 |
|---|---|
| Provider Enumeration Date | 06/18/2015 |
| Last Update Date | 01/13/2024 |
| Certification Date | 01/13/2024 |
| Medicare PECOS PAC ID | 0648544510 |
|---|---|
| Medicare Enrollment ID | O20170918000297 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1174905830 | NPI | - | NPPES |
| 1194765420 | Other | GA | NPI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YP2500X | Counselor - Professional | 038495 (Georgia) | Secondary |
| 261Q00000X | Clinic/center | 038495 (Georgia) | Primary |
| Provider Name | Emantavius M Williams |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1760871420 PECOS PAC ID: 7517250350 Enrollment ID: I20160801001650 |
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