| La Clinique Llc | |
|
1240 N Thornton Ave Dalton GA 30720-3605 | |
| (706) 229-9313 | |
| (706) 229-9388 |
| Full Name | La Clinique Llc |
|---|---|
| Speciality | Internal Medicine |
| Location | 1240 N Thornton Ave, Dalton, Georgia |
| Authorized Official Name and Position | Ramses Vega-casasnovas (OWNER) |
| Authorized Official Contact | 3366886240 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| La Clinique Llc 1240 N Thornton Ave Dalton GA 30720-3605 Ph: (706) 229-9313 | La Clinique Llc 1240 N Thornton Ave Dalton GA 30720-3605 Ph: (706) 229-9313 |
| NPI Number | 1285401901 |
|---|---|
| Provider Enumeration Date | 12/04/2023 |
| Last Update Date | 12/04/2023 |
| Medicare PECOS PAC ID | 0840637393 |
|---|---|
| Medicare Enrollment ID | O20240320002180 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1285401901 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | (* (Not Available)) | Primary |
| Provider Name | Amy Lynn Garner |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1962970400 PECOS PAC ID: 4385985944 Enrollment ID: I20190408002542 |
| Provider Name | Ramses L Vega-casasnovas |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1073741369 PECOS PAC ID: 5092964833 Enrollment ID: I20200922000880 |
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