| Maxa Internal Medicine Associates Pc | |
|
3505 Duluth Park Ln Building 4, Ste 400 Duluth GA 30096-3201 | |
| (678) 597-3180 | |
| (678) 597-3181 |
| Full Name | Maxa Internal Medicine Associates Pc |
|---|---|
| Speciality | Clinic/Center |
| Location | 3505 Duluth Park Ln, Duluth, Georgia |
| Authorized Official Name and Position | Ashleigh Maxa (PRACTICE ADMINISTRATOR) |
| Authorized Official Contact | 6785973180 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Maxa Internal Medicine Associates Pc 3505 Duluth Park Ln Building 4, Ste 400 Duluth GA 30096-3201 Ph: (678) 597-3180 | Maxa Internal Medicine Associates Pc 3505 Duluth Park Ln Building 4, Ste 400 Duluth GA 30096-3201 Ph: (678) 597-3180 |
| NPI Number | 1902957152 |
|---|---|
| Provider Enumeration Date | 01/15/2007 |
| Last Update Date | 07/19/2011 |
| Medicare PECOS PAC ID | 7113831017 |
|---|---|
| Medicare Enrollment ID | O20031114000565 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1902957152 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | (* (Not Available)) | Primary |
| Provider Name | Benigno B Bobon |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1487645032 PECOS PAC ID: 3274547252 Enrollment ID: I20060130000068 |
| Provider Name | Lauren Houlday |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1700168234 PECOS PAC ID: 0840463469 Enrollment ID: I20111026000933 |
| Provider Name | Richard Reid Maxa |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1144371386 PECOS PAC ID: 1254245152 Enrollment ID: I20111026000939 |
| Provider Name | Laura Elizabeth Vanhook |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1669811410 PECOS PAC ID: 7911140249 Enrollment ID: I20130905000222 |
| Provider Name | Marguerite Horen Bobon |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1558795229 PECOS PAC ID: 8729212394 Enrollment ID: I20131015000346 |
| Provider Name | Elizabeth Cercone |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1821335993 PECOS PAC ID: 2769709385 Enrollment ID: I20150319001251 |
| Provider Name | Alexandra Leigh Ruiz |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1538557061 PECOS PAC ID: 6901188473 Enrollment ID: I20170117002283 |
| Provider Name | Cori Folkes Harrell |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1245578954 PECOS PAC ID: 7517106388 Enrollment ID: I20171031000887 |
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