| |
1920 Monroe Dr Ne Ste 100 Atlanta GA 30324-4880 | |
(618) 979-5091 | |
Not Available |
Full Name | |
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Speciality | Internal Medicine |
Location | 1920 Monroe Dr Ne Ste 100, Atlanta, Georgia |
Authorized Official Name and Position | Victoria Grinston (CEO) |
Authorized Official Contact | 6189795091 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
---|---|
1920 Monroe Dr Ne Ste 100 Atlanta GA 30324-4880 Ph: (618) 979-5091 | 1920 Monroe Dr Ne Ste 100 Atlanta GA 30324-4880 Ph: (618) 979-5091 |
NPI Number | 1063091262 |
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Provider Enumeration Date | 04/05/2021 |
Last Update Date | 12/28/2023 |
Medicare PECOS PAC ID | 7113310426 |
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Medicare Enrollment ID | O20220209002185 |
Identifier | Type | State | Issuer |
---|---|---|---|
1063091262 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
207RG0300X | Internal Medicine - Geriatric Medicine | (* (Not Available)) | Primary |
Provider Name | James Rogan |
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Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1982704300 PECOS PAC ID: 5597740217 Enrollment ID: I20220209002269 |
Provider Name | Thai-hao Nguyen |
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Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1609296557 PECOS PAC ID: 7618286634 Enrollment ID: I20240222001002 |
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