| Eagles Landing Family Practice, Llc | |
|
62 Kelly Rd Mcdonough GA 30253-6012 | |
| (770) 914-0116 | |
| (770) 914-7703 |
| Full Name | Eagles Landing Family Practice, Llc |
|---|---|
| Speciality | Family Medicine |
| Location | 62 Kelly Rd, Mcdonough, Georgia |
| Authorized Official Name and Position | Jeff Mitcham (COO) |
| Authorized Official Contact | 7709140116 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Eagles Landing Family Practice, Llc 62 Kelly Rd Mcdonough GA 30253-6012 Ph: (770) 914-0116 | Eagles Landing Family Practice, Llc 62 Kelly Rd Mcdonough GA 30253-6012 Ph: (770) 914-0116 |
| NPI Number | 1902907207 |
|---|---|
| Provider Enumeration Date | 09/26/2006 |
| Last Update Date | 02/06/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1902907207 | NPI | - | NPPES |
| 061407 | Other | GA | BC/BS OF GA GROUP |
| CC6012 | Other | GA | RAILROAD MEDICARE |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | 29378 (Georgia) | Primary |
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