| Northeast Georgia Diagnostic Clinic Llc | |
|
1240 Jesse Jewell Pkwy Se Suite 500 Gainesville GA 30501-3862 | |
| (770) 536-9864 | |
| (770) 297-5023 |
| Full Name | Northeast Georgia Diagnostic Clinic Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 1240 Jesse Jewell Pkwy Se, Gainesville, Georgia |
| Authorized Official Name and Position | Margaret Gaskill (REVENUE CYCLE DIRECTOR) |
| Authorized Official Contact | 7705369864 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Northeast Georgia Diagnostic Clinic Llc 1240 Jesse Jewell Pkwy Se Suite 500 Gainesville GA 30501-3862 Ph: (770) 536-9864 | Northeast Georgia Diagnostic Clinic Llc 1240 Jesse Jewell Pkwy Se Suite 500 Gainesville GA 30501-3862 Ph: (770) 536-9864 |
| NPI Number | 1215976634 |
|---|---|
| Provider Enumeration Date | 06/05/2006 |
| Last Update Date | 09/20/2017 |
| Medicare PECOS PAC ID | 5092700377 |
|---|---|
| Medicare Enrollment ID | O20040416000499 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1215976634 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM1300X | Clinic/center - Multi-specialty | (* (Not Available)) | Primary |
| Provider Name | Lalitha Bandi |
|---|---|
| Provider Type | Practitioner - Nephrology |
| Provider Identifiers | NPI Number: 1942203138 PECOS PAC ID: 4880668730 Enrollment ID: I20040825000785 |
| Provider Name | Bradley H Pierce |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1841293818 PECOS PAC ID: 5193790475 Enrollment ID: I20040831000198 |
| Provider Name | Wesley D Head |
|---|---|
| Provider Type | Practitioner - Critical Care (intensivists) |
| Provider Identifiers | NPI Number: 1487657508 PECOS PAC ID: 4587611207 Enrollment ID: I20050405000939 |
| Provider Name | Andre M Kallab |
|---|---|
| Provider Type | Practitioner - Hematology/oncology |
| Provider Identifiers | NPI Number: 1669475760 PECOS PAC ID: 0244272383 Enrollment ID: I20050527000704 |
| Provider Name | Joseph E West |
|---|---|
| Provider Type | Practitioner - Pulmonary Disease |
| Provider Identifiers | NPI Number: 1043375025 PECOS PAC ID: 5294770913 Enrollment ID: I20050623000165 |
| Provider Name | Christopher S Bussler |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1609879881 PECOS PAC ID: 7012943061 Enrollment ID: I20050712000472 |
| Provider Name | Cacia Soares Welch |
|---|---|
| Provider Type | Practitioner - Endocrinology |
| Provider Identifiers | NPI Number: 1295738151 PECOS PAC ID: 8527098607 Enrollment ID: I20050818000193 |
| Provider Name | Matthey T Harris |
|---|---|
| Provider Type | Practitioner - Endocrinology |
| Provider Identifiers | NPI Number: 1043213176 PECOS PAC ID: 4284664137 Enrollment ID: I20050819000480 |
| Provider Name | Mini J Shivprasad |
|---|---|
| Provider Type | Practitioner - Geriatric Medicine |
| Provider Identifiers | NPI Number: 1407836158 PECOS PAC ID: 8325074834 Enrollment ID: I20060323000691 |
| Provider Name | Tracy L Lovell |
|---|---|
| Provider Type | Practitioner - Rheumatology |
| Provider Identifiers | NPI Number: 1821066952 PECOS PAC ID: 5092727495 Enrollment ID: I20060630000079 |
| Provider Name | Saloni H Tanna |
|---|---|
| Provider Type | Practitioner - Medical Oncology |
| Provider Identifiers | NPI Number: 1760422117 PECOS PAC ID: 0749293835 Enrollment ID: I20060712000239 |
| Provider Name | Theron E Hawkins |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1699817098 PECOS PAC ID: 6507960093 Enrollment ID: I20070322000095 |
| Provider Name | Sylvia T Dold |
|---|---|
| Provider Type | Practitioner - Rheumatology |
| Provider Identifiers | NPI Number: 1326088873 PECOS PAC ID: 7416969936 Enrollment ID: I20070511000340 |
| Provider Name | Sherry A Davis |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1184820128 PECOS PAC ID: 4981798147 Enrollment ID: I20070919000041 |
| Provider Name | Thomas G Murray |
|---|---|
| Provider Type | Practitioner - Pulmonary Disease |
| Provider Identifiers | NPI Number: 1972506947 PECOS PAC ID: 9638254451 Enrollment ID: I20080304000488 |
| Provider Name | Padma C Nadella |
|---|---|
| Provider Type | Practitioner - Hematology/oncology |
| Provider Identifiers | NPI Number: 1548375660 PECOS PAC ID: 7113096603 Enrollment ID: I20080523000491 |
| Provider Name | Paul H Chenard |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1174796874 PECOS PAC ID: 3971540824 Enrollment ID: I20080530000152 |
| Provider Name | Alok Sachdeva |
|---|---|
| Provider Type | Practitioner - Rheumatology |
| Provider Identifiers | NPI Number: 1750504262 PECOS PAC ID: 4183795156 Enrollment ID: I20080618000586 |
| Provider Name | Mark Kats |
|---|---|
| Provider Type | Practitioner - Nephrology |
| Provider Identifiers | NPI Number: 1215140355 PECOS PAC ID: 5496822736 Enrollment ID: I20080929000165 |
| Provider Name | Christina A Saurel |
|---|---|
| Provider Type | Practitioner - Medical Oncology |
| Provider Identifiers | NPI Number: 1104025154 PECOS PAC ID: 3971697442 Enrollment ID: I20080929000272 |
| Provider Name | Brian J Wechter |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1760639207 PECOS PAC ID: 2961561931 Enrollment ID: I20081105000445 |
| Provider Name | Brent J Archer |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1073702916 PECOS PAC ID: 9133271851 Enrollment ID: I20090710000132 |
| Provider Name | Craig M Brown |
|---|---|
| Provider Type | Practitioner - Pulmonary Disease |
| Provider Identifiers | NPI Number: 1063680882 PECOS PAC ID: 2769534239 Enrollment ID: I20090714000402 |
| Provider Name | Richard J Gomez |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1316940554 PECOS PAC ID: 8426065103 Enrollment ID: I20100119000081 |
| Provider Name | Sean M Sumner |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1093718942 PECOS PAC ID: 4587706700 Enrollment ID: I20100126000272 |
| Provider Name | Dawn M Sosebee |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1083610711 PECOS PAC ID: 3870635063 Enrollment ID: I20100127000020 |
| Provider Name | Jeffrey C Terry |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1124021761 PECOS PAC ID: 4789726977 Enrollment ID: I20100127000021 |
| Provider Name | Jennifer A Roark |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1952307670 PECOS PAC ID: 1153463260 Enrollment ID: I20100127000360 |
| Provider Name | Laura Anne Shepherd |
|---|---|
| Provider Type | Practitioner - Nephrology |
| Provider Identifiers | NPI Number: 1730162926 PECOS PAC ID: 6204968969 Enrollment ID: I20100715000190 |
| Provider Name | Hillary S Morgan |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1851400022 PECOS PAC ID: 7315945482 Enrollment ID: I20100803000255 |
| Provider Name | Amy Roark |
|---|---|
| Provider Type | Practitioner - Registered Dietitian Or Nutrition Professional |
| Provider Identifiers | NPI Number: 1699771311 PECOS PAC ID: 8022132935 Enrollment ID: I20100830000670 |
| Provider Name | Roberto M Villanueva |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1033112958 PECOS PAC ID: 7618091497 Enrollment ID: I20100831000545 |
| Provider Name | Eniki A Mack |
|---|---|
| Provider Type | Practitioner - Endocrinology |
| Provider Identifiers | NPI Number: 1730307927 PECOS PAC ID: 3870679822 Enrollment ID: I20100910000051 |
| Provider Name | Jennifer M John |
|---|---|
| Provider Type | Practitioner - Endocrinology |
| Provider Identifiers | NPI Number: 1447343140 PECOS PAC ID: 0648375642 Enrollment ID: I20101027000218 |
| Provider Name | Birju B Patel |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1093771347 PECOS PAC ID: 7911181862 Enrollment ID: I20110418000613 |
| Provider Name | Richard E Blatt |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1699951871 PECOS PAC ID: 3678740230 Enrollment ID: I20120123000300 |
| Provider Name | Kim T Tran |
|---|---|
| Provider Type | Practitioner - Nephrology |
| Provider Identifiers | NPI Number: 1972710465 PECOS PAC ID: 1951557107 Enrollment ID: I20120803000584 |
| Provider Name | Mitzi B Lovell |
|---|---|
| Provider Type | Practitioner - Registered Dietitian Or Nutrition Professional |
| Provider Identifiers | NPI Number: 1194721837 PECOS PAC ID: 1052564176 Enrollment ID: I20130123000218 |
| Provider Name | Robert Scott Barrett |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1780902411 PECOS PAC ID: 8921233370 Enrollment ID: I20131021001199 |
| Provider Name | Daniel M Henson |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1780687756 PECOS PAC ID: 5991024846 Enrollment ID: I20150428000823 |
| Provider Name | Ryan M Nadelson |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1407110703 PECOS PAC ID: 2769630284 Enrollment ID: I20150707001244 |
| Provider Name | Sherry H Flanagan |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1427413962 PECOS PAC ID: 7618271594 Enrollment ID: I20160215000018 |
| Provider Name | Lauren Darnell |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1780128272 PECOS PAC ID: 3476835547 Enrollment ID: I20170125001005 |
| Provider Name | April Lian Young |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1366968091 PECOS PAC ID: 9234403379 Enrollment ID: I20170927004632 |
| Provider Name | Melissa Summerlin |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1043519671 PECOS PAC ID: 7810253127 Enrollment ID: I20171101003438 |
| Provider Name | Sreedevi Veluvarti Avdhani |
|---|---|
| Provider Type | Practitioner - Endocrinology |
| Provider Identifiers | NPI Number: 1235490780 PECOS PAC ID: 3577885102 Enrollment ID: I20181011000976 |
William T. Jones, M.d.,pc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 1098 S Enota Dr Ne, Gainesville, GA 30501 Phone: 770-532-4517 Fax: 770-503-0267 | |
Dr Johnny J Di Blasi Do Pc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 3 Washington Ave, Gainesville, GA 30501 Phone: 904-482-9673 | |
Primary Care Clinics Of Georgia Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 1240 Jesse Jewell Pkwy Se, Suite 370, Gainesville, GA 30501 Phone: 770-536-1004 Fax: 770-536-0905 | |
Hall County Health Department Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 1290 Athens St, Gainesville, GA 30507 Phone: 770-532-5344 | |
Gastroenterology Associates Of Gainesville, P. C. Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 2324 Limestone Overlook, Gainesville, GA 30501 Phone: 770-536-8109 Fax: 770-536-3203 | |
Annual Wellness Centers Of America Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 3030 Mcever Rd, Suite 300, Gainesville, GA 30504 Phone: 770-503-0021 | |
Ortho Sport & Spine Gainesville Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 1990 Limestone Cir, Gainesville, GA 30501 Phone: 678-752-7246 |