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7810 Mcginnis Ferry Rd Suite #108 Suwanee GA 30024-1633 | |
(770) 622-9446 | |
Not Available |
Full Name | |
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Speciality | Clinic/Center |
Location | 7810 Mcginnis Ferry Rd, Suwanee, Georgia |
Authorized Official Name and Position | Jill Russell (MEMBER) |
Authorized Official Contact | 7706229446 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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7325 Amberleigh Way Duluth GA 30097-1873 Ph: (404) 514-4139 | 7810 Mcginnis Ferry Rd Suite #108 Suwanee GA 30024-1633 Ph: (770) 622-9446 |
NPI Number | 1255665170 |
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Provider Enumeration Date | 09/24/2009 |
Last Update Date | 07/21/2022 |
Medicare PECOS PAC ID | 8921143058 |
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Medicare Enrollment ID | O20100301000668 |
Identifier | Type | State | Issuer |
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1255665170 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
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261Q00000X | Clinic/center | (Georgia) | Primary |
Provider Name | Jill Russell |
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Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1457370223 PECOS PAC ID: 5092723171 Enrollment ID: I20060331000108 |
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