Commonwealth Primary Care | |
1614 Peachtree Pkwy Suite # 200 Cumming GA 30041-6883 | |
(678) 455-2295 | |
(678) 455-2279 |
Full Name | Commonwealth Primary Care |
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Speciality | Clinic/Center |
Location | 1614 Peachtree Pkwy, Cumming, Georgia |
Authorized Official Name and Position | Jayasri Mallavarapu (CEO) |
Authorized Official Contact | 6784552295 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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Commonwealth Primary Care 1614 Peachtree Pkwy Suite # 200 Cumming GA 30041-6883 Ph: (678) 455-2295 | Commonwealth Primary Care 1614 Peachtree Pkwy Suite # 200 Cumming GA 30041-6883 Ph: (678) 455-2295 |
NPI Number | 1982033411 |
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Provider Enumeration Date | 11/05/2013 |
Last Update Date | 03/25/2014 |
Medicare PECOS PAC ID | 6800027558 |
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Medicare Enrollment ID | O20140506000486 |
Identifier | Type | State | Issuer |
---|---|---|---|
1982033411 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QP2300X | Clinic/center - Primary Care | 061288 (Georgia) | Primary |
Provider Name | Jayasri Mallavarapu |
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Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1235309469 PECOS PAC ID: 2466511555 Enrollment ID: I20081104000473 |
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