Community Care Md | |
5019 Lavista Rd Tucker GA 30084-3541 | |
(678) 720-0422 | |
(678) 720-0440 |
Full Name | Community Care Md |
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Speciality | Clinic/Center |
Location | 5019 Lavista Rd, Tucker, Georgia |
Authorized Official Name and Position | Jane A Ling (DIRECTOR OF OP) |
Authorized Official Contact | 6787200422 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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Community Care Md 5019 Lavista Rd Tucker GA 30084-3541 Ph: (678) 720-0422 | Community Care Md 5019 Lavista Rd Tucker GA 30084-3541 Ph: (678) 720-0422 |
NPI Number | 1730221649 |
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Provider Enumeration Date | 02/14/2007 |
Last Update Date | 08/22/2020 |
Medicare PECOS PAC ID | 7618869090 |
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Medicare Enrollment ID | O20040329001447 |
Identifier | Type | State | Issuer |
---|---|---|---|
1730221649 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
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261Q00000X | Clinic/center | 156221 (Georgia) | Primary |
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