| |
3154 Abbey Dr Sw Atlanta GA 30331-5467 | |
(404) 803-5246 | |
(770) 991-5012 |
Full Name | |
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Speciality | Internal Medicine |
Location | 3154 Abbey Dr Sw, Atlanta, Georgia |
Authorized Official Name and Position | Miguel Elhalcon Stubbs (CEO) |
Authorized Official Contact | 4048035246 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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3154 Abbey Dr Sw Atlanta GA 30331-5467 Ph: (404) 803-5246 | 3154 Abbey Dr Sw Atlanta GA 30331-5467 Ph: (404) 803-5246 |
NPI Number | 1093176778 |
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Provider Enumeration Date | 03/09/2016 |
Last Update Date | 03/09/2016 |
Medicare PECOS PAC ID | 2264847201 |
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Medicare Enrollment ID | O20210224002128 |
Identifier | Type | State | Issuer |
---|---|---|---|
1093176778 | NPI | - | NPPES |
00603006I | Medicaid | GA |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
207R00000X | Internal Medicine | 037708 (Georgia) | Primary |
Provider Name | Miguel E Stubbs |
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Provider Type | Practitioner - Internal Medicine |
Provider Identifiers | NPI Number: 1477591675 PECOS PAC ID: 6709867591 Enrollment ID: I20040527000407 |
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