| Peachstate Family Clinic, Llc | |
|
4319 Lawrenceville Hwy Nw Lilburn GA 30047-3416 | |
| (678) 583-8888 | |
| Not Available |
| Full Name | Peachstate Family Clinic, Llc |
|---|---|
| Speciality | Family Medicine |
| Location | 4319 Lawrenceville Hwy Nw, Lilburn, Georgia |
| Authorized Official Name and Position | Changchun Wu (PHYSICIAN) |
| Authorized Official Contact | 6785838888 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Peachstate Family Clinic, Llc 4319 Lawrenceville Hwy Nw Lilburn GA 30047-3416 Ph: (678) 583-8888 | Peachstate Family Clinic, Llc 4319 Lawrenceville Hwy Nw Lilburn GA 30047-3416 Ph: (678) 583-8888 |
| NPI Number | 1346754041 |
|---|---|
| Provider Enumeration Date | 11/17/2017 |
| Last Update Date | 11/17/2017 |
| Medicare PECOS PAC ID | 9133474240 |
|---|---|
| Medicare Enrollment ID | O20180613002292 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1346754041 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | 061537 (Georgia) | Primary |
| Provider Name | Changchun A Wu |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1265642821 PECOS PAC ID: 6608930508 Enrollment ID: I20090121000295 |
| Provider Name | Lauren P Cole |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1780375261 PECOS PAC ID: 6709236532 Enrollment ID: I20231220001332 |
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