Mountain Lakes Physicians Group | |
180 Legacy Pt Ste 200 Clayton GA 30525-5354 | |
(706) 782-3100 | |
Not Available |
Full Name | Mountain Lakes Physicians Group |
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Speciality | Clinic/Center |
Location | 180 Legacy Pt Ste 200, Clayton, Georgia |
Authorized Official Name and Position | Kristy Hall (CHIEF EXECUTIVE OFFICER) |
Authorized Official Contact | 7067820400 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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Mountain Lakes Physicians Group 162 Legacy Pt Clayton GA 30525-5354 Ph: () - | Mountain Lakes Physicians Group 180 Legacy Pt Ste 200 Clayton GA 30525-5354 Ph: (706) 782-3100 |
NPI Number | 1386339141 |
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Provider Enumeration Date | 04/07/2023 |
Last Update Date | 10/23/2024 |
Medicare PECOS PAC ID | 1052342854 |
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Medicare Enrollment ID | O20230501002685 |
Identifier | Type | State | Issuer |
---|---|---|---|
1386339141 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
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261QR1300X | Clinic/center - Rural Health | (* (Not Available)) | Primary |
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