| Om Primary Care Llc | |
|
4300 Westbrook Rd Bldg A Suwanee GA 30024-4987 | |
| (470) 416-3424 | |
| Not Available |
| Full Name | Om Primary Care Llc |
|---|---|
| Speciality | Family Medicine |
| Location | 4300 Westbrook Rd Bldg A, Suwanee, Georgia |
| Authorized Official Name and Position | Kinjal Amit Kachalia (DIRECTOR) |
| Authorized Official Contact | 4704163424 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Om Primary Care Llc 220 Newport Fairway Alpharetta GA 30005-7825 Ph: (470) 416-3424 | Om Primary Care Llc 4300 Westbrook Rd Bldg A Suwanee GA 30024-4987 Ph: (470) 416-3424 |
| NPI Number | 1841800679 |
|---|---|
| Provider Enumeration Date | 08/06/2020 |
| Last Update Date | 08/06/2020 |
| Medicare PECOS PAC ID | 8628498177 |
|---|---|
| Medicare Enrollment ID | O20201021002930 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1841800679 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| 207R00000X | Internal Medicine | (* (Not Available)) | Secondary |
| Provider Name | Farhad M Yazdi |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1366534661 PECOS PAC ID: 0941481527 Enrollment ID: I20110302000581 |
| Provider Name | Vishal K Burra |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1831350578 PECOS PAC ID: 2365612389 Enrollment ID: I20110831000344 |
| Provider Name | Amit G Kachalia |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1770821621 PECOS PAC ID: 2365662038 Enrollment ID: I20200109002635 |
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