| Pai Participant 11 Pc | |
|
415 Airport Rd Griffin GA 30224-4834 | |
| (770) 227-8636 | |
| Not Available |
| Full Name | Pai Participant 11 Pc |
|---|---|
| Speciality | Internal Medicine |
| Location | 415 Airport Rd, Griffin, Georgia |
| Authorized Official Name and Position | Erin N Laird (AUTHORIZED OFFICIAL) |
| Authorized Official Contact | 4104588713 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Pai Participant 11 Pc Po Box 639676 Cincinnati OH 45263-9676 Ph: (859) 291-4800 | Pai Participant 11 Pc 415 Airport Rd Griffin GA 30224-4834 Ph: (770) 227-8636 |
| NPI Number | 1144887720 |
|---|---|
| Provider Enumeration Date | 05/20/2019 |
| Last Update Date | 08/10/2020 |
| Medicare PECOS PAC ID | 9638405897 |
|---|---|
| Medicare Enrollment ID | O20190725000706 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1144887720 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207RG0300X | Internal Medicine - Geriatric Medicine | (* (Not Available)) | Primary |
| Provider Name | Zia Khan |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1427122092 PECOS PAC ID: 2668436684 Enrollment ID: I20100825000476 |
| Provider Name | Charles A Bergstrom |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1104886662 PECOS PAC ID: 0244429876 Enrollment ID: I20110112000493 |
| Provider Name | Joy Blumberg |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1437675394 PECOS PAC ID: 7618243221 Enrollment ID: I20171026002533 |
| Provider Name | Laura P Slack |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1497051767 PECOS PAC ID: 0244401727 Enrollment ID: I20190723001571 |
| Provider Name | Monique Jennifer Stage |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1174048474 PECOS PAC ID: 5991134389 Enrollment ID: I20200406003379 |
| Provider Name | Syeda Khan |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1366639221 PECOS PAC ID: 6103915756 Enrollment ID: I20200902001554 |
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