| Laraya Family Medicine - Medicina Familar Llc | |
|
6570 Stage Rd Ste 100 Bartlett TN 38134-2839 | |
| (901) 949-2316 | |
| Not Available |
| Full Name | Laraya Family Medicine - Medicina Familar Llc |
|---|---|
| Speciality | Family Medicine |
| Location | 6570 Stage Rd Ste 100, Bartlett, Tennessee |
| Authorized Official Name and Position | Jose Aria Gharavi Laraya (OWNER) |
| Authorized Official Contact | 9019492316 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Laraya Family Medicine - Medicina Familar Llc Po Box 931263 Atlanta GA 31193-1263 Ph: (901) 949-2316 | Laraya Family Medicine - Medicina Familar Llc 6570 Stage Rd Ste 100 Bartlett TN 38134-2839 Ph: (901) 949-2316 |
| NPI Number | 1164102133 |
|---|---|
| Provider Enumeration Date | 07/24/2023 |
| Last Update Date | 09/08/2023 |
| Medicare PECOS PAC ID | 2860856531 |
|---|---|
| Medicare Enrollment ID | O20230913003200 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1164102133 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| Provider Name | Jose A Laraya |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1639120868 PECOS PAC ID: 8426088394 Enrollment ID: I20050819000674 |
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