| Clarkston Primary & Urgent Care, Llc | |
|
4600 E Ponce De Leon Ave Ste A Clarkston GA 30021-1839 | |
| (770) 703-5408 | |
| (877) 779-5837 |
| Full Name | Clarkston Primary & Urgent Care, Llc |
|---|---|
| Speciality | Family Medicine |
| Location | 4600 E Ponce De Leon Ave Ste A, Clarkston, Georgia |
| Authorized Official Name and Position | Etsubdenke Areaya (AUTHORIZED OFFICIAL) |
| Authorized Official Contact | 6787632247 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Clarkston Primary & Urgent Care, Llc 4600 E Ponce De Leon Ave Ste A Clarkston GA 30021-1839 Ph: (770) 703-5408 | Clarkston Primary & Urgent Care, Llc 4600 E Ponce De Leon Ave Ste A Clarkston GA 30021-1839 Ph: (770) 703-5408 |
| NPI Number | 1043781420 |
|---|---|
| Provider Enumeration Date | 12/11/2018 |
| Last Update Date | 12/11/2018 |
| Medicare PECOS PAC ID | 9537401450 |
|---|---|
| Medicare Enrollment ID | O20190425000289 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1043781420 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| Provider Name | Berhanu Kededa |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1184994105 PECOS PAC ID: 5991957011 Enrollment ID: I20121218000085 |
| Provider Name | Yonas Tamene |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1679097893 PECOS PAC ID: 2365709805 Enrollment ID: I20171207003420 |
| Provider Name | Estubdenke Areaya |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1790233120 PECOS PAC ID: 2769724541 Enrollment ID: I20190426001476 |
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