| Legacy Physician Consultants, Llc | |
|
209 Peach Orchard Rd Baldwin GA 30511-1803 | |
| (706) 713-1904 | |
| Not Available |
| Full Name | Legacy Physician Consultants, Llc |
|---|---|
| Speciality | Internal Medicine |
| Location | 209 Peach Orchard Rd, Baldwin, Georgia |
| Authorized Official Name and Position | Michael William Myers (COO) |
| Authorized Official Contact | 7065020503 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Legacy Physician Consultants, Llc 555 Forest Rd Athens GA 30605-3823 Ph: (706) 502-0503 | Legacy Physician Consultants, Llc 209 Peach Orchard Rd Baldwin GA 30511-1803 Ph: (706) 713-1904 |
| NPI Number | 1508605668 |
|---|---|
| Provider Enumeration Date | 05/20/2024 |
| Last Update Date | 05/20/2024 |
| Medicare PECOS PAC ID | 7911431457 |
|---|---|
| Medicare Enrollment ID | O20241106003804 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1508605668 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Secondary |
| 207R00000X | Internal Medicine | (* (Not Available)) | Primary |
| Provider Name | Anthony D Sagel |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1871530303 PECOS PAC ID: 9436180999 Enrollment ID: I20050824000497 |
| Provider Name | Linda Idun |
|---|---|
| Provider Type | Practitioner - Hospitalist |
| Provider Identifiers | NPI Number: 1609047844 PECOS PAC ID: 8224109145 Enrollment ID: I20120523000368 |
| Provider Name | Pramod Kakarala |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1972881795 PECOS PAC ID: 0143473850 Enrollment ID: I20140930001782 |
| Provider Name | Arpit A Shah |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1083844518 PECOS PAC ID: 6901054089 Enrollment ID: I20160504002818 |
| Provider Name | Marie Leblanc-riley |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1790145563 PECOS PAC ID: 5698014512 Enrollment ID: I20190311001827 |
| Provider Name | Gregory Wilkerson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1053950246 PECOS PAC ID: 2860806940 Enrollment ID: I20210201002445 |
| Provider Name | Dipal N Patel |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1922568203 PECOS PAC ID: 1153700505 Enrollment ID: I20220615002578 |
Premise Health Of Georgia Medical, P.c. Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 184 Professional Dr Unit B, Baldwin, GA 30511 Phone: 706-894-2714 Fax: 706-894-2715 |