| Lotus Family Wellness Clinic, Llc | |
|
1240 Highway 138 Sw Riverdale GA 30296-1402 | |
| (404) 668-1827 | |
| Not Available |
| Full Name | Lotus Family Wellness Clinic, Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 1240 Highway 138 Sw, Riverdale, Georgia |
| Authorized Official Name and Position | Qiana Aidah Johnson (OWNER/FAMILY NURSE PRACTITIONER) |
| Authorized Official Contact | 4046681827 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Lotus Family Wellness Clinic, Llc 280 Bonnie Ln Fayetteville GA 30215-8802 Ph: (404) 668-1827 | Lotus Family Wellness Clinic, Llc 1240 Highway 138 Sw Riverdale GA 30296-1402 Ph: (404) 668-1827 |
| NPI Number | 1013497171 |
|---|---|
| Provider Enumeration Date | 08/17/2018 |
| Last Update Date | 08/17/2018 |
| Medicare PECOS PAC ID | 0749527422 |
|---|---|
| Medicare Enrollment ID | O20190204002209 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1013497171 | NPI | - | NPPES |
| 003151631F | Medicaid | GA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | (* (Not Available)) | Primary |
| Provider Name | Qiana Johnson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1043629363 PECOS PAC ID: 5799074894 Enrollment ID: I20190204002969 |
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