| Personalized Primary Care Of Atlanta Llc | |
|
57 Executive Park S Ste 390 Atlanta GA 30329-2288 | |
| (404) 371-1033 | |
| (404) 997-6790 |
| Full Name | Personalized Primary Care Of Atlanta Llc |
|---|---|
| Speciality | Internal Medicine |
| Location | 57 Executive Park S, Atlanta, Georgia |
| Authorized Official Name and Position | Juliet K. Mavromatis (PRESIDENT/OWNER) |
| Authorized Official Contact | 4045830978 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Personalized Primary Care Of Atlanta Llc 57 Executive Park S Ste 390 Atlanta GA 30329-2255 Ph: (404) 997-6790 | Personalized Primary Care Of Atlanta Llc 57 Executive Park S Ste 390 Atlanta GA 30329-2288 Ph: (404) 371-1033 |
| NPI Number | 1740506427 |
|---|---|
| Provider Enumeration Date | 04/20/2010 |
| Last Update Date | 11/01/2022 |
| Medicare PECOS PAC ID | 4789717018 |
|---|---|
| Medicare Enrollment ID | O20100806000095 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1740506427 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | 043699 (Georgia) | Primary |
| Provider Name | Juliet K Mavromatis |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1528168747 PECOS PAC ID: 1658397930 Enrollment ID: I20051017000137 |
| Provider Name | Phyllis S Tong |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1376651190 PECOS PAC ID: 7719179977 Enrollment ID: I20101006000173 |
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