| Icecare Llc | |
|
976 Mansell Rd Roswell GA 30076-1533 | |
| (770) 800-3277 | |
| (770) 800-3537 |
| Full Name | Icecare Llc |
|---|---|
| Speciality | Family Medicine |
| Location | 976 Mansell Rd, Roswell, Georgia |
| Authorized Official Name and Position | Anthony Chukwuemeka C Iwelunmor (MD) |
| Authorized Official Contact | 7708003277 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Icecare Llc 976 Mansell Rd Roswell GA 30076-1533 Ph: (770) 800-3277 | Icecare Llc 976 Mansell Rd Roswell GA 30076-1533 Ph: (770) 800-3277 |
| NPI Number | 1366202236 |
|---|---|
| Provider Enumeration Date | 03/19/2024 |
| Last Update Date | 03/19/2024 |
| Medicare PECOS PAC ID | 6800237942 |
|---|---|
| Medicare Enrollment ID | O20240507003723 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1366202236 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| 207RN0300X | Internal Medicine - Nephrology | (* (Not Available)) | Secondary |
| Provider Name | Amanda L Iwelunmor |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1154749356 PECOS PAC ID: 0547547150 Enrollment ID: I20170509002206 |
| Provider Name | Anthony Iluyomade |
|---|---|
| Provider Type | Practitioner - Nephrology |
| Provider Identifiers | NPI Number: 1437554250 PECOS PAC ID: 8022352855 Enrollment ID: I20181205003466 |
| Provider Name | Anita Carol English |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1124689856 PECOS PAC ID: 7113256876 Enrollment ID: I20190906000454 |
| Provider Name | Cindy Liberal |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1659922508 PECOS PAC ID: 1658706239 Enrollment ID: I20200109001471 |
| Provider Name | Anthony C Iwelunmor |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1033571799 PECOS PAC ID: 7719271691 Enrollment ID: I20200303000467 |
| Provider Name | Shanay Francine Smith |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1316728611 PECOS PAC ID: 9537515374 Enrollment ID: I20231030003424 |
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