| Medsouth Associates Pc | |
|
483 Upper Riverdale Rd Sw Ste G Riverdale GA 30274-2584 | |
| (770) 996-9400 | |
| (770) 991-2918 |
| Full Name | Medsouth Associates Pc |
|---|---|
| Speciality | Internal Medicine |
| Location | 483 Upper Riverdale Rd Sw Ste G, Riverdale, Georgia |
| Authorized Official Name and Position | Richard Wright (OFFICE MANAGER) |
| Authorized Official Contact | 7709969400 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Medsouth Associates Pc 483 Upper Riverdale Rd Sw Ste G Riverdale GA 30274-2584 Ph: (770) 996-9400 | Medsouth Associates Pc 483 Upper Riverdale Rd Sw Ste G Riverdale GA 30274-2584 Ph: (770) 996-9400 |
| NPI Number | 1508057589 |
|---|---|
| Provider Enumeration Date | 08/06/2007 |
| Last Update Date | 03/12/2020 |
| Medicare PECOS PAC ID | 4587578232 |
|---|---|
| Medicare Enrollment ID | O20031117000610 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1508057589 | NPI | - | NPPES |
| 000897949A | Medicaid | GA | |
| 000252238A | Medicaid | GA | |
| 000892581F | Medicaid | GA | |
| 003004 | Other | BC | |
| 149377 | Other | BC | |
| 855141 | Other | BC |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | 022956 (Georgia) | Primary |
| 207R00000X | Internal Medicine | 036647 (Georgia) | Secondary |
| 207R00000X | Internal Medicine | 046927 (Georgia) | Secondary |
| Provider Name | Richard I Wright |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1770573552 PECOS PAC ID: 6002830114 Enrollment ID: I20060117000238 |
| Provider Name | Paul Lawrence Harvey |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1053410357 PECOS PAC ID: 4981897634 Enrollment ID: I20101026000820 |
| Provider Name | Eloy Edilberto Diaz |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1063461051 PECOS PAC ID: 6507770260 Enrollment ID: I20101026000885 |
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