Eagle Medical Center | |
804 Bombay Ln Roswell GA 30076-5819 | |
(770) 754-9880 | |
(770) 754-9881 |
Full Name | Eagle Medical Center |
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Speciality | General Practice |
Location | 804 Bombay Ln, Roswell, Georgia |
Authorized Official Name and Position | Kimberly Green (PHYSICIAN) |
Authorized Official Contact | 7707549880 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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Eagle Medical Center 804 Bombay Ln Roswell GA 30076-5819 Ph: () - | Eagle Medical Center 804 Bombay Ln Roswell GA 30076-5819 Ph: (770) 754-9880 |
NPI Number | 1073810453 |
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Provider Enumeration Date | 02/19/2011 |
Last Update Date | 02/19/2011 |
Medicare PECOS PAC ID | 6507047636 |
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Medicare Enrollment ID | O20110223000389 |
Identifier | Type | State | Issuer |
---|---|---|---|
1073810453 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
208D00000X | General Practice | 058478 (Georgia) | Primary |
208VP0000X | Pain Medicine - Pain Medicine | 058478 (Georgia) | Secondary |
Provider Name | Kimberly J Green |
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Provider Type | Practitioner - General Practice |
Provider Identifiers | NPI Number: 1720174873 PECOS PAC ID: 7719987296 Enrollment ID: I20070106000109 |
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