| Comprehensive Primary And Urgent Care Llc | |
|
6131 S Norcross Tucker Rd Ste 6 Norcross GA 30093-5536 | |
| (678) 205-1959 | |
| (770) 710-0721 |
| Full Name | Comprehensive Primary And Urgent Care Llc |
|---|---|
| Speciality | Family Medicine |
| Location | 6131 S Norcross Tucker Rd Ste 6, Norcross, Georgia |
| Authorized Official Name and Position | Thomas Vincent Moore (CEO) |
| Authorized Official Contact | 4048843321 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Comprehensive Primary And Urgent Care Llc 6131 S Norcross Tucker Rd Ste 6 Norcross GA 30093-5536 Ph: (678) 205-1959 | Comprehensive Primary And Urgent Care Llc 6131 S Norcross Tucker Rd Ste 6 Norcross GA 30093-5536 Ph: (678) 205-1959 |
| NPI Number | 1770097719 |
|---|---|
| Provider Enumeration Date | 11/29/2017 |
| Last Update Date | 11/08/2023 |
| Medicare PECOS PAC ID | 8921341082 |
|---|---|
| Medicare Enrollment ID | O20190514000911 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1770097719 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| 207X00000X | Orthopaedic Surgery | (* (Not Available)) | Secondary |
| Provider Name | Miles D Johnson |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1568419844 PECOS PAC ID: 2466437157 Enrollment ID: I20040618000358 |
| Provider Name | Ademola A Opanuga |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1255584355 PECOS PAC ID: 4183896699 Enrollment ID: I20111005000514 |
| Provider Name | Dana E Lee |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1659515609 PECOS PAC ID: 9830456052 Enrollment ID: I20171127000857 |
| Provider Name | Audra E Moore |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1194107631 PECOS PAC ID: 3173839743 Enrollment ID: I20190515001334 |
| Provider Name | Magaly Colon |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1235615238 PECOS PAC ID: 5496098253 Enrollment ID: I20190517000879 |
| Provider Name | Aline Bayard |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1972961068 PECOS PAC ID: 2466756291 Enrollment ID: I20191009001084 |
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