| Georgia Medical Clinic | |
|
4415 Front Nine Dr Ste 600 Cumming GA 30041-6239 | |
| (770) 744-7688 | |
| (770) 406-1058 |
| Full Name | Georgia Medical Clinic |
|---|---|
| Speciality | Internal Medicine |
| Location | 4415 Front Nine Dr Ste 600, Cumming, Georgia |
| Authorized Official Name and Position | Venkatappa Rangaraj (OWNER) |
| Authorized Official Contact | 5132183468 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Georgia Medical Clinic 4415 Front Nine Dr Ste 600 Cumming GA 30041-6239 Ph: (770) 744-7688 | Georgia Medical Clinic 4415 Front Nine Dr Ste 600 Cumming GA 30041-6239 Ph: (770) 744-7688 |
| NPI Number | 1124361811 |
|---|---|
| Provider Enumeration Date | 04/01/2013 |
| Last Update Date | 02/14/2023 |
| Medicare PECOS PAC ID | 2163667643 |
|---|---|
| Medicare Enrollment ID | O20130404000400 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1124361811 | NPI | - | NPPES |
| 003132617A | Medicaid | GA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | 058633 (Georgia) | Primary |
| Provider Name | Angella V Samuels |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1043406069 PECOS PAC ID: 4486732088 Enrollment ID: I20080423000105 |
| Provider Name | Venkatappa Ramesh Rangaraj |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1588690879 PECOS PAC ID: 0042213126 Enrollment ID: I20080814000144 |
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