| Hillandale Medical Associates, Pc | |
|
5910 Hillandale Dr Suite 202 Lithonia GA 30058-1884 | |
| (770) 808-0092 | |
| (770) 808-0380 |
| Full Name | Hillandale Medical Associates, Pc |
|---|---|
| Speciality | Internal Medicine |
| Location | 5910 Hillandale Dr, Lithonia, Georgia |
| Authorized Official Name and Position | Sherell D Vicks (OWNER) |
| Authorized Official Contact | 7708080092 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Hillandale Medical Associates, Pc 5910 Hillandale Dr Suite 202 Lithonia GA 30058-1884 Ph: (770) 808-0092 | Hillandale Medical Associates, Pc 5910 Hillandale Dr Suite 202 Lithonia GA 30058-1884 Ph: (770) 808-0092 |
| NPI Number | 1598962706 |
|---|---|
| Provider Enumeration Date | 06/29/2007 |
| Last Update Date | 08/22/2020 |
| Medicare PECOS PAC ID | 7012808942 |
|---|---|
| Medicare Enrollment ID | O20040322000905 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1598962706 | NPI | - | NPPES |
| 00641935C | Medicaid | GA | |
| 11BDTLM | Medicaid | GA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | 34265 (Georgia) | Primary |
| Provider Name | Sherell Vicks |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1932251253 PECOS PAC ID: 6709777634 Enrollment ID: I20110830000359 |
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