| Creekside Medical Clinic Llc | |
|
3104 Creekside Village Dr Nw Suite 201 Kennesaw GA 30144-2324 | |
| (770) 627-3986 | |
| (770) 872-0517 |
| Full Name | Creekside Medical Clinic Llc |
|---|---|
| Speciality | Family Medicine |
| Location | 3104 Creekside Village Dr Nw, Kennesaw, Georgia |
| Authorized Official Name and Position | Sharmila Ramprasad (DIRECTOR) |
| Authorized Official Contact | 7706273986 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Creekside Medical Clinic Llc 3104 Creekside Village Dr Nw Suite 201 Kennesaw GA 30144-2324 Ph: (770) 627-3986 | Creekside Medical Clinic Llc 3104 Creekside Village Dr Nw Suite 201 Kennesaw GA 30144-2324 Ph: (770) 627-3986 |
| NPI Number | 1518289248 |
|---|---|
| Provider Enumeration Date | 02/22/2010 |
| Last Update Date | 08/15/2022 |
| Medicare PECOS PAC ID | 9234260233 |
|---|---|
| Medicare Enrollment ID | O20100707000409 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1518289248 | NPI | - | NPPES |
| 839516023A | Medicaid | GA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| Provider Name | Sharmila Ramprasad |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1093724908 PECOS PAC ID: 3870593346 Enrollment ID: I20070106000011 |
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