| Lavista Family Medicine | |
|
2910 N Druid Hills Rd Ne Suite A Atlanta GA 30329-3919 | |
| (404) 320-6050 | |
| (404) 320-6080 |
| Full Name | Lavista Family Medicine |
|---|---|
| Speciality | Clinic/Center |
| Location | 2910 N Druid Hills Rd Ne, Atlanta, Georgia |
| Authorized Official Name and Position | Mikhail Gorokhov (FAMILY PRACTICE) |
| Authorized Official Contact | 4043206050 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Lavista Family Medicine 2012 Harobi Dr Suite B Tucker GA 30084-5161 Ph: (404) 320-6050 | Lavista Family Medicine 2910 N Druid Hills Rd Ne Suite A Atlanta GA 30329-3919 Ph: (404) 320-6050 |
| NPI Number | 1538333497 |
|---|---|
| Provider Enumeration Date | 04/22/2008 |
| Last Update Date | 10/24/2013 |
| Medicare PECOS PAC ID | 1153518949 |
|---|---|
| Medicare Enrollment ID | O20101206000779 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1538333497 | NPI | - | NPPES |
| 000662219E | Medicaid | GA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | 039353 (Georgia) | Primary |
| 261QP2300X | Clinic/center - Primary Care | 042048 (Georgia) | Secondary |
| Provider Name | Mikhail Gorokhov |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1922116599 PECOS PAC ID: 9133316920 Enrollment ID: I20101206000818 |
| Provider Name | Tatyana Gorokhov |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1750499315 PECOS PAC ID: 2264668581 Enrollment ID: I20131115000096 |
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