| Caedel Medical Group | |
|
1324 Highway 138 Sw Riverdale GA 30296-1404 | |
| (770) 907-4949 | |
| (770) 907-4022 |
| Full Name | Caedel Medical Group |
|---|---|
| Speciality | Internal Medicine |
| Location | 1324 Highway 138 Sw, Riverdale, Georgia |
| Authorized Official Name and Position | Claire K Willie (PHYSICIAN/OWNER) |
| Authorized Official Contact | 7709074949 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Caedel Medical Group Po Box 9 Fayetteville GA 30214-0009 Ph: (770) 907-4949 | Caedel Medical Group 1324 Highway 138 Sw Riverdale GA 30296-1404 Ph: (770) 907-4949 |
| NPI Number | 1710922075 |
|---|---|
| Provider Enumeration Date | 06/19/2006 |
| Last Update Date | 08/02/2011 |
| Medicare PECOS PAC ID | 0648258988 |
|---|---|
| Medicare Enrollment ID | O20040712001450 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1710922075 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | 039177 (Georgia) | Primary |
| Provider Name | Claire K Willie |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1790711141 PECOS PAC ID: 6608764550 Enrollment ID: I20040310000988 |
| Provider Name | James Oliviere |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1891977146 PECOS PAC ID: 9537247143 Enrollment ID: I20080423000248 |
| Provider Name | Grace M. Ibeanusi |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1366776924 PECOS PAC ID: 5991980872 Enrollment ID: I20110420000334 |
| Provider Name | Jodi Tallman |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1194188516 PECOS PAC ID: 0941591895 Enrollment ID: I20160623000883 |
| Provider Name | Gloria Lucille Harden |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1295387645 PECOS PAC ID: 5890127245 Enrollment ID: I20191122002622 |
| Provider Name | Shontiaya S Patterson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1063762870 PECOS PAC ID: 5698189801 Enrollment ID: I20210129001627 |
| Provider Name | Thuy Ha Bao Trinh |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1477172641 PECOS PAC ID: 5092121806 Enrollment ID: I20210302002624 |
| Provider Name | Zabeena B Dharani |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1184322257 PECOS PAC ID: 0143688531 Enrollment ID: I20230616000201 |
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