| Maldonado & Moreno, Pc | |
|
375 Mcdonough Rd Jackson GA 30233-1509 | |
| (770) 775-4622 | |
| Not Available |
| Full Name | Maldonado & Moreno, Pc |
|---|---|
| Speciality | Family Medicine |
| Location | 375 Mcdonough Rd, Jackson, Georgia |
| Authorized Official Name and Position | Cathy Washington (BILLING) |
| Authorized Official Contact | 7707754622 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Maldonado & Moreno, Pc 375 Mcdonough Rd Jackson GA 30233-1509 Ph: () - | Maldonado & Moreno, Pc 375 Mcdonough Rd Jackson GA 30233-1509 Ph: (770) 775-4622 |
| NPI Number | 1699815340 |
|---|---|
| Provider Enumeration Date | 02/08/2007 |
| Last Update Date | 04/10/2015 |
| Medicare PECOS PAC ID | 5890989016 |
|---|---|
| Medicare Enrollment ID | O20101102000612 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1699815340 | NPI | - | NPPES |
| 555980929C | Medicaid | GA | |
| 000211549A | Medicaid | GA | |
| 000885024A | Medicaid | GA | |
| GRP4245 | Other | GA | MEDICARE GROUP # |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | 046792 (Georgia) | Primary |
| 207Q00000X | Family Medicine | 022255 (Georgia) | Secondary |
| 225X00000X | Occupational Therapist | OT002221 (Georgia) | Secondary |
| Provider Name | Jorge L Moreno |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1518914597 PECOS PAC ID: 7315851417 Enrollment ID: I20031113000447 |
| Provider Name | Jorge L Moreno |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1518904242 PECOS PAC ID: 6800791427 Enrollment ID: I20031205000188 |
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