| Mayuga Family Medicine Llc | |
|
236b Stockbridge Rd Jonesboro GA 30236-3629 | |
| (770) 742-9326 | |
| (862) 298-0871 |
| Full Name | Mayuga Family Medicine Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 236b Stockbridge Rd, Jonesboro, Georgia |
| Authorized Official Name and Position | Tom John Albunian Mayuga (OWNER) |
| Authorized Official Contact | 7707429326 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Mayuga Family Medicine Llc 1575 Harvest Ln Alpharetta GA 30004-6741 Ph: (770) 742-9326 | Mayuga Family Medicine Llc 236b Stockbridge Rd Jonesboro GA 30236-3629 Ph: (770) 742-9326 |
| NPI Number | 1972203735 |
|---|---|
| Provider Enumeration Date | 03/09/2023 |
| Last Update Date | 03/13/2023 |
| Medicare PECOS PAC ID | 5496111262 |
|---|---|
| Medicare Enrollment ID | O20230522000161 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1972203735 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | (* (Not Available)) | Primary |
| Provider Name | Tom John Albunian Mayuga |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1902433246 PECOS PAC ID: 6305202177 Enrollment ID: I20230522001305 |
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