| Moultrie Medical Pc | |
|
2970 Clairmont Rd Ne Ste 210 Brookhaven GA 30329-4414 | |
| (256) 302-3505 | |
| Not Available |
| Full Name | Moultrie Medical Pc |
|---|---|
| Speciality | Clinic/Center |
| Location | 2970 Clairmont Rd Ne Ste 210, Brookhaven, Georgia |
| Authorized Official Name and Position | John Moultrie (OWNER) |
| Authorized Official Contact | 2563023505 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Moultrie Medical Pc 2847 Cedar Canyon Ct Ne Atlanta GA 30345-4021 Ph: (256) 302-3505 | Moultrie Medical Pc 2970 Clairmont Rd Ne Ste 210 Brookhaven GA 30329-4414 Ph: (256) 302-3505 |
| NPI Number | 1215618640 |
|---|---|
| Provider Enumeration Date | 07/27/2023 |
| Last Update Date | 07/27/2023 |
| Medicare PECOS PAC ID | 9335592104 |
|---|---|
| Medicare Enrollment ID | O20240129000517 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1215618640 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | (* (Not Available)) | Primary |
| Provider Name | John Caldwell Moultrie |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1417393893 PECOS PAC ID: 6608017306 Enrollment ID: I20160912001514 |
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