| Integra Clinical Services, Llc-ga | |
|
135 Riverside Pkwy Sw Austell GA 30168-7749 | |
| (844) 856-9355 | |
| (844) 856-9355 |
| Full Name | Integra Clinical Services, Llc-ga |
|---|---|
| Speciality | Internal Medicine |
| Location | 135 Riverside Pkwy Sw, Austell, Georgia |
| Authorized Official Name and Position | Eric Nixon (OWNER) |
| Authorized Official Contact | 8448569355 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Integra Clinical Services, Llc-ga 8063 Westside Blvd Fulton MD 20759-2464 Ph: (844) 856-9355 | Integra Clinical Services, Llc-ga 135 Riverside Pkwy Sw Austell GA 30168-7749 Ph: (844) 856-9355 |
| NPI Number | 1144821323 |
|---|---|
| Provider Enumeration Date | 11/04/2020 |
| Last Update Date | 11/04/2020 |
| Medicare PECOS PAC ID | 1759793433 |
|---|---|
| Medicare Enrollment ID | O20201222002191 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1144821323 | NPI | - | NPPES |
| Provider Name | Mboh E Elango |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1487822391 PECOS PAC ID: 2961575519 Enrollment ID: I20080716000021 |
| Provider Name | Susan Castle |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1083858716 PECOS PAC ID: 9931396595 Enrollment ID: I20101208000475 |
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