| Minaxi, Llc | |
|
3524 Lost Tree Ct Martinez GA 30907-9500 | |
| (706) 267-7681 | |
| Not Available |
| Full Name | Minaxi, Llc |
|---|---|
| Speciality | Internal Medicine |
| Location | 3524 Lost Tree Ct, Martinez, Georgia |
| Authorized Official Name and Position | Hetal Thakore (OWNER) |
| Authorized Official Contact | 7062677681 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Minaxi, Llc 3524 Lost Tree Ct Martinez GA 30907-9500 Ph: (706) 267-7681 | Minaxi, Llc 3524 Lost Tree Ct Martinez GA 30907-9500 Ph: (706) 267-7681 |
| NPI Number | 1063872372 |
|---|---|
| Provider Enumeration Date | 02/29/2016 |
| Last Update Date | 02/29/2016 |
| Medicare PECOS PAC ID | 0840598207 |
|---|---|
| Medicare Enrollment ID | O20160419000051 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1063872372 | NPI | - | NPPES |
| 1821184540 | Other | GA | INDIVIDUAL NPI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (Georgia) | Secondary |
| 207R00000X | Internal Medicine | (* (Not Available)) | Primary |
| Provider Name | Karen L Gibbons-berry |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1861448227 PECOS PAC ID: 8820077498 Enrollment ID: I20040716000652 |
| Provider Name | Jon Christopher Gibbs |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1700896156 PECOS PAC ID: 2466497532 Enrollment ID: I20050621000202 |
| Provider Name | Hetal P Thakore |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1821184540 PECOS PAC ID: 3476650821 Enrollment ID: I20070518000194 |
| Provider Name | Jonathan Preston |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1912327248 PECOS PAC ID: 3375830250 Enrollment ID: I20160920002344 |
| Provider Name | Pedro Hevia Paez |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1942790878 PECOS PAC ID: 4587917737 Enrollment ID: I20181105002989 |
| Provider Name | Beverly Natashia Ficklin |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1982069258 PECOS PAC ID: 1658709654 Enrollment ID: I20200324003482 |
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