| Cpacs-cosmo Health Center | |
|
6185 Buford Hwy Bldg B Peachtree Corners GA 30071-2350 | |
| (770) 936-0969 | |
| Not Available |
| Full Name | Cpacs-cosmo Health Center |
|---|---|
| Speciality | Clinic/Center |
| Location | 6185 Buford Hwy Bldg B, Peachtree Corners, Georgia |
| Authorized Official Name and Position | Chaiwon Kim (CHIEF EXECUTIVE OFFICER) |
| Authorized Official Contact | 7709360969 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Cpacs-cosmo Health Center 3510 Shallowford Rd Ne Atlanta GA 30341-2909 Ph: (770) 936-0969 | Cpacs-cosmo Health Center 6185 Buford Hwy Bldg B Peachtree Corners GA 30071-2350 Ph: (770) 936-0969 |
| NPI Number | 1336493311 |
|---|---|
| Provider Enumeration Date | 10/30/2012 |
| Last Update Date | 03/27/2023 |
| Medicare PECOS PAC ID | 1355569765 |
|---|---|
| Medicare Enrollment ID | O20140827000843 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1336493311 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |
| Provider Name | Jong K Song |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1568511301 PECOS PAC ID: 8022074079 Enrollment ID: I20041202000082 |
| Provider Name | Sooil Kim |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1972660355 PECOS PAC ID: 7012101421 Enrollment ID: I20101029000921 |
| Provider Name | Deema Elchoufi |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1205350691 PECOS PAC ID: 6406292143 Enrollment ID: I20240315002541 |
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