| Angelic Clinical Services, Llc | |
|
1500 Juneau Way Grayson GA 30017-2962 | |
| (770) 568-2777 | |
| (678) 819-0877 |
| Full Name | Angelic Clinical Services, Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 1500 Juneau Way, Grayson, Georgia |
| Authorized Official Name and Position | Joy Stanetrice Wilson (FAMILY NURSE PRACTITIONER/OWNER) |
| Authorized Official Contact | 7542249512 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Angelic Clinical Services, Llc 1500 Juneau Way Grayson GA 30017-2962 Ph: (770) 568-2777 | Angelic Clinical Services, Llc 1500 Juneau Way Grayson GA 30017-2962 Ph: (770) 568-2777 |
| NPI Number | 1497299440 |
|---|---|
| Provider Enumeration Date | 12/09/2016 |
| Last Update Date | 05/10/2017 |
| Medicare PECOS PAC ID | 5890072227 |
|---|---|
| Medicare Enrollment ID | O20170511001933 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1497299440 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | (* (Not Available)) | Primary |
| Provider Name | Joy S Wilson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1477723732 PECOS PAC ID: 8820249725 Enrollment ID: I20121126000519 |
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