| Clinica Vital, Llc | |
|
3661 Clairmont Rd Chamblee GA 30341-4907 | |
| (770) 797-5167 | |
| (404) 891-6343 |
| Full Name | Clinica Vital, Llc |
|---|---|
| Speciality | Family Medicine |
| Location | 3661 Clairmont Rd, Chamblee, Georgia |
| Authorized Official Name and Position | Melissa Salcido (CEO) |
| Authorized Official Contact | 7707975167 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Clinica Vital, Llc 3661 Clairmont Rd Chamblee GA 30341-4907 Ph: (770) 797-5167 | Clinica Vital, Llc 3661 Clairmont Rd Chamblee GA 30341-4907 Ph: (770) 797-5167 |
| NPI Number | 1780374645 |
|---|---|
| Provider Enumeration Date | 05/12/2023 |
| Last Update Date | 05/12/2023 |
| Medicare PECOS PAC ID | 6002259819 |
|---|---|
| Medicare Enrollment ID | O20240208003005 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1780374645 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| 208000000X | Pediatrics | (* (Not Available)) | Secondary |
| Provider Name | Jose A Batista |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1780906792 PECOS PAC ID: 2365885183 Enrollment ID: I20240208003401 |
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