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2709 Airport Rd Dalton GA 30721-0252 | |
(706) 275-4444 | |
(706) 275-6515 |
Full Name | |
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Speciality | Family Medicine |
Location | 2709 Airport Rd, Dalton, Georgia |
Authorized Official Name and Position | Holly Bullock (PRACTICE MANAGER) |
Authorized Official Contact | 7062754444 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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2709 Airport Rd Dalton GA 30721-0252 Ph: (706) 275-4444 | 2709 Airport Rd Dalton GA 30721-0252 Ph: (706) 275-4444 |
NPI Number | 1558141135 |
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Provider Enumeration Date | 10/02/2023 |
Last Update Date | 10/27/2023 |
Medicare PECOS PAC ID | 4284082710 |
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Medicare Enrollment ID | O20231122001036 |
Identifier | Type | State | Issuer |
---|---|---|---|
1558141135 | NPI | - | NPPES |
1447304316 | Medicaid | GA |
Taxonomy | Type | License (State) | Status |
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207Q00000X | Family Medicine | (* (Not Available)) | Primary |
Provider Name | Gretchen Diaz-lopez |
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Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1447304316 PECOS PAC ID: 3476453770 Enrollment ID: I20040112000389 |
Provider Name | Thomas L Garcia |
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Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1710144324 PECOS PAC ID: 7012051980 Enrollment ID: I20100216000130 |
I D Specialist Dalton P C Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 1200 E Walnut Ave Ste 4, Dalton, GA 30721 Phone: 706-428-8908 | |
The Deo Clinic, Inc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 218 N Fredrick St, Dalton, GA 30721 Phone: 706-581-2009 Fax: 706-529-5055 | |