| Physician Management Services Of Eastern Georgia, Llc | |
|
410 Peachtree Pkwy Suite 4260 Cumming GA 30041-7066 | |
| (888) 829-8550 | |
| Not Available |
| Full Name | Physician Management Services Of Eastern Georgia, Llc |
|---|---|
| Speciality | Family Medicine |
| Location | 410 Peachtree Pkwy, Cumming, Georgia |
| Authorized Official Name and Position | Brett Kenefick (PRESIDENT) |
| Authorized Official Contact | 8888298550 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Physician Management Services Of Eastern Georgia, Llc 3113 Lawton Rd Suite 250 Orlando FL 32803-3531 Ph: (888) 829-8550 | Physician Management Services Of Eastern Georgia, Llc 410 Peachtree Pkwy Suite 4260 Cumming GA 30041-7066 Ph: (888) 829-8550 |
| NPI Number | 1780125294 |
|---|---|
| Provider Enumeration Date | 03/16/2017 |
| Last Update Date | 03/16/2017 |
| Medicare PECOS PAC ID | 6800124413 |
|---|---|
| Medicare Enrollment ID | O20190821000191 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1780125294 | NPI | - | NPPES |
| PHC059 | Other | MEDICARE PTAN |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | 049380 (Georgia) | Primary |
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