| Hillandale Internal Medicine, Pc | |
|
5900 Hillandale Dr Annex E Lithonia GA 30058-3802 | |
| (770) 987-8400 | |
| (770) 987-8494 |
| Full Name | Hillandale Internal Medicine, Pc |
|---|---|
| Speciality | Internal Medicine |
| Location | 5900 Hillandale Dr, Lithonia, Georgia |
| Authorized Official Name and Position | Wallace Duncan (CEO) |
| Authorized Official Contact | 7709878400 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Hillandale Internal Medicine, Pc 5900 Hillandale Dr Annex E Lithonia GA 30058-3802 Ph: (770) 987-8400 | Hillandale Internal Medicine, Pc 5900 Hillandale Dr Annex E Lithonia GA 30058-3802 Ph: (770) 987-8400 |
| NPI Number | 1861781320 |
|---|---|
| Provider Enumeration Date | 04/05/2011 |
| Last Update Date | 04/05/2011 |
| Medicare PECOS PAC ID | 5890968184 |
|---|---|
| Medicare Enrollment ID | O20111102000196 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1861781320 | NPI | - | NPPES |
| 00687893G | Medicaid | GA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | 041109 (Georgia) | Primary |
| Provider Name | Wallace Duncan |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1821153529 PECOS PAC ID: 6002707601 Enrollment ID: I20040323000961 |
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