Faebris Medical & Community Education | |
3939 Lavista Rd Ste E-310 Tucker GA 30084-5162 | |
(770) 905-2347 | |
Not Available |
Full Name | Faebris Medical & Community Education |
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Speciality | Internal Medicine |
Location | 3939 Lavista Rd Ste E-310, Tucker, Georgia |
Authorized Official Name and Position | Zandraetta L Tims-cook (OWNER) |
Authorized Official Contact | 7709052347 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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Faebris Medical & Community Education 3939 Lavista Rd Ste E-310 Tucker GA 30084-5162 Ph: (770) 905-2347 | Faebris Medical & Community Education 3939 Lavista Rd Ste E-310 Tucker GA 30084-5162 Ph: (770) 905-2347 |
NPI Number | 1942635081 |
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Provider Enumeration Date | 09/09/2013 |
Last Update Date | 09/09/2013 |
Medicare PECOS PAC ID | 5799919544 |
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Medicare Enrollment ID | O20131009001544 |
Identifier | Type | State | Issuer |
---|---|---|---|
1942635081 | NPI | - | NPPES |
15382816338 | Other | NPI INDIVIDUAL |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
207RI0200X | Internal Medicine - Infectious Disease | (* (Not Available)) | Primary |
Provider Name | Zandraetta L Tims-cook |
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Provider Type | Practitioner - Infectious Disease |
Provider Identifiers | NPI Number: 1538216338 PECOS PAC ID: 9234322710 Enrollment ID: I20101015000803 |
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