Mill Creek Clinic, Llc | |
7824 Hickory Flat Hwy Ste 120 Woodstock GA 30188-6575 | |
(770) 604-1930 | |
(770) 604-1929 |
Full Name | Mill Creek Clinic, Llc |
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Speciality | Clinic/Center |
Location | 7824 Hickory Flat Hwy Ste 120, Woodstock, Georgia |
Authorized Official Name and Position | Sheryl Bailey Vickery (OWNER) |
Authorized Official Contact | 7703780328 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
---|---|
Mill Creek Clinic, Llc 6175 Hickory Flat Hwy Ste 110-343 Canton GA 30115-7207 Ph: (770) 704-4911 | Mill Creek Clinic, Llc 7824 Hickory Flat Hwy Ste 120 Woodstock GA 30188-6575 Ph: (770) 604-1930 |
NPI Number | 1700278199 |
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Provider Enumeration Date | 02/23/2015 |
Last Update Date | 03/19/2019 |
Medicare PECOS PAC ID | 3971818683 |
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Medicare Enrollment ID | O20150810002210 |
Identifier | Type | State | Issuer |
---|---|---|---|
1700278199 | NPI | - | NPPES |
883092643D | Medicaid | GA |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QP2300X | Clinic/center - Primary Care | 26446 (Georgia) | Primary |
261QP2300X | Clinic/center - Primary Care | (* (Not Available)) | Secondary |
Provider Name | Sheryl A Vickery |
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Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1538226220 PECOS PAC ID: 6800884115 Enrollment ID: I20040505000383 |
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