| Four Corners @ Vph | |
|
5300 Oakbrook Pkwy Suite 130 Norcross GA 30093-2256 | |
| (770) 279-3142 | |
| (770) 234-5210 |
| Full Name | Four Corners @ Vph |
|---|---|
| Speciality | Clinic/Center |
| Location | 5300 Oakbrook Pkwy, Norcross, Georgia |
| Authorized Official Name and Position | Brian O. Williams (CEO) |
| Authorized Official Contact | 7702793140 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Four Corners @ Vph 5300 Oakbrook Pkwy Suite 130 Norcross GA 30093-2256 Ph: (770) 279-3142 | Four Corners @ Vph 5300 Oakbrook Pkwy Suite 130 Norcross GA 30093-2256 Ph: (770) 279-3142 |
| NPI Number | 1265624548 |
|---|---|
| Provider Enumeration Date | 08/10/2007 |
| Last Update Date | 09/01/2016 |
| Medicare PECOS PAC ID | 1951497494 |
|---|---|
| Medicare Enrollment ID | O20071015000519 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1265624548 | NPI | - | NPPES |
| 162765396A | Medicaid | GA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |
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