| Lakeside Family Medicine | |
|
104 Carrington Park Dr Ste B Gainesville GA 30504-6603 | |
| (770) 899-3773 | |
| Not Available |
| Full Name | Lakeside Family Medicine |
|---|---|
| Speciality | Clinic/Center |
| Location | 104 Carrington Park Dr Ste B, Gainesville, Georgia |
| Authorized Official Name and Position | Foroogh Narmani-mohammadi (FAMILY NURSE PRACTITIONER) |
| Authorized Official Contact | 7708993773 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Lakeside Family Medicine 104 Carrington Park Dr Ste B Gainesville GA 30504-6603 Ph: (770) 899-3773 | Lakeside Family Medicine 104 Carrington Park Dr Ste B Gainesville GA 30504-6603 Ph: (770) 899-3773 |
| NPI Number | 1720514029 |
|---|---|
| Provider Enumeration Date | 05/04/2017 |
| Last Update Date | 05/04/2017 |
| Medicare PECOS PAC ID | 4082989843 |
|---|---|
| Medicare Enrollment ID | O20171004000325 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1720514029 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | F0514016 (Georgia) | Primary |
| Provider Name | Foroogh Narmani-mohammadi |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1447659347 PECOS PAC ID: 3678878758 Enrollment ID: I20160226002154 |
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