| Advanced Internal Medicine | |
|
235 Medical Blvd Suite B Stockbridge GA 30281-7218 | |
| (770) 960-8855 | |
| (678) 565-1140 |
| Full Name | Advanced Internal Medicine |
|---|---|
| Speciality | Clinic/Center |
| Location | 235 Medical Blvd, Stockbridge, Georgia |
| Authorized Official Name and Position | Faosat O Odemuyiwa (MANAGER) |
| Authorized Official Contact | 7709608855 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Advanced Internal Medicine Po Box 870116 Morrow GA 30287-0116 Ph: (770) 960-8855 | Advanced Internal Medicine 235 Medical Blvd Suite B Stockbridge GA 30281-7218 Ph: (770) 960-8855 |
| NPI Number | 1669658829 |
|---|---|
| Provider Enumeration Date | 01/17/2008 |
| Last Update Date | 06/30/2010 |
| Medicare PECOS PAC ID | 6204863764 |
|---|---|
| Medicare Enrollment ID | O20050726000984 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1669658829 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | 07-12143 (Georgia) | Primary |
| Provider Name | Abdul O Odemuyiwa |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1528161437 PECOS PAC ID: 3274560735 Enrollment ID: I20110311000692 |
| Provider Name | Maxine Mitchell |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1104970441 PECOS PAC ID: 4385746288 Enrollment ID: I20160209001660 |
| Provider Name | Levi Jelks |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1306333083 PECOS PAC ID: 5193136927 Enrollment ID: I20201130000484 |
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