| Family Practice Of Conyers Inc | |
|
1039 E Freeway Dr Se Conyers GA 30094-5965 | |
| (770) 922-0076 | |
| (770) 922-0734 |
| Full Name | Family Practice Of Conyers Inc |
|---|---|
| Speciality | Family Medicine |
| Location | 1039 E Freeway Dr Se, Conyers, Georgia |
| Authorized Official Name and Position | Alvin Vincent Griffin (MEDICAL DIRECTOR) |
| Authorized Official Contact | 7709220076 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Family Practice Of Conyers Inc 1039 E Freeway Dr Se Conyers GA 30094-5965 Ph: (770) 922-0076 | Family Practice Of Conyers Inc 1039 E Freeway Dr Se Conyers GA 30094-5965 Ph: (770) 922-0076 |
| NPI Number | 1720146301 |
|---|---|
| Provider Enumeration Date | 12/05/2006 |
| Last Update Date | 06/20/2023 |
| Medicare PECOS PAC ID | 0244227387 |
|---|---|
| Medicare Enrollment ID | O20040429000552 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1720146301 | NPI | - | NPPES |
| 00412849I | Medicaid | GA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| Provider Name | Alvin Vincent Griffin |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1033102868 PECOS PAC ID: 4284885799 Enrollment ID: I20121109000422 |
| Provider Name | Erica Nicole Neely |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1710627948 PECOS PAC ID: 9234505181 Enrollment ID: I20221018000172 |
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