| Livingwell Medical Clinic Llc | |
|
4760 Austell Rd Ste 3 Austell GA 30106-2007 | |
| (770) 726-2477 | |
| Not Available |
| Full Name | Livingwell Medical Clinic Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 4760 Austell Rd Ste 3, Austell, Georgia |
| Authorized Official Name and Position | Eugennie Gloria Williams (FAMILY NURSE PRACTITIONER) |
| Authorized Official Contact | 7707262477 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Livingwell Medical Clinic Llc 4760 Austell Rd Ste 3 Austell GA 30106-2007 Ph: (770) 726-2477 | Livingwell Medical Clinic Llc 4760 Austell Rd Ste 3 Austell GA 30106-2007 Ph: (770) 726-2477 |
| NPI Number | 1306615281 |
|---|---|
| Provider Enumeration Date | 12/20/2023 |
| Last Update Date | 01/16/2024 |
| Medicare PECOS PAC ID | 3274986690 |
|---|---|
| Medicare Enrollment ID | O20240201000319 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1306615281 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | (* (Not Available)) | Primary |
| Provider Name | Eugennie Gloria Williams-rose |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1710695895 PECOS PAC ID: 7012382245 Enrollment ID: I20230331000690 |
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