| Pickens Primary Care Llc | |
|
744 Noah Dr # 108-109 Jasper GA 30143-8705 | |
| (706) 692-0119 | |
| Not Available |
| Full Name | Pickens Primary Care Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 744 Noah Dr # 108-109, Jasper, Georgia |
| Authorized Official Name and Position | Jesus Vazquez-figueroa (OWNER) |
| Authorized Official Contact | 7066920119 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Pickens Primary Care Llc 790 Champions Club Dr Alpharetta GA 30004-6955 Ph: (404) 984-8357 | Pickens Primary Care Llc 744 Noah Dr # 108-109 Jasper GA 30143-8705 Ph: (706) 692-0119 |
| NPI Number | 1467044529 |
|---|---|
| Provider Enumeration Date | 02/09/2021 |
| Last Update Date | 03/11/2021 |
| Medicare PECOS PAC ID | 5496162406 |
|---|---|
| Medicare Enrollment ID | O20210318000618 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1467044529 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | (* (Not Available)) | Primary |
| Provider Name | Jesus Gustavo Vazquez-figueroa |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1982918678 PECOS PAC ID: 7719119973 Enrollment ID: I20170201002012 |
| Provider Name | Daniel Dean |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1689292203 PECOS PAC ID: 9436574563 Enrollment ID: I20200805003061 |
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