| Pmc Long Term Care, Llc | |
|
190 Greencastle Rd # 2 Tyrone GA 30290-2936 | |
| (770) 487-7807 | |
| (770) 487-7619 |
| Full Name | Pmc Long Term Care, Llc |
|---|---|
| Speciality | Internal Medicine |
| Location | 190 Greencastle Rd # 2, Tyrone, Georgia |
| Authorized Official Name and Position | Zia Khan (OWNER) |
| Authorized Official Contact | 7704877807 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Pmc Long Term Care, Llc 190 Greencastle Rd # 2 Tyrone GA 30290-2936 Ph: (770) 487-7807 | Pmc Long Term Care, Llc 190 Greencastle Rd # 2 Tyrone GA 30290-2936 Ph: (770) 487-7807 |
| NPI Number | 1699396457 |
|---|---|
| Provider Enumeration Date | 05/04/2020 |
| Last Update Date | 07/06/2020 |
| Medicare PECOS PAC ID | 9638595754 |
|---|---|
| Medicare Enrollment ID | O20200819001738 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1699396457 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | (* (Not Available)) | Primary |
| Provider Name | James T Tippett |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1235225822 PECOS PAC ID: 1759330798 Enrollment ID: I20050118000382 |
| Provider Name | Mark Couch |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1770641953 PECOS PAC ID: 1456381532 Enrollment ID: I20050818000181 |
| Provider Name | Zia Khan |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1427122092 PECOS PAC ID: 2668436684 Enrollment ID: I20100825000476 |
| Provider Name | Charles A Bergstrom |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1104886662 PECOS PAC ID: 0244429876 Enrollment ID: I20110112000493 |
| Provider Name | Amanda J Hutchinson |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1861600975 PECOS PAC ID: 0143465344 Enrollment ID: I20130806000377 |
| Provider Name | Joy Blumberg |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1437675394 PECOS PAC ID: 7618243221 Enrollment ID: I20171026002533 |
| Provider Name | Monique Jennifer Stage |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1174048474 PECOS PAC ID: 5991134389 Enrollment ID: I20200406003379 |
| Provider Name | Syeda Khan |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1366639221 PECOS PAC ID: 6103915756 Enrollment ID: I20200902001554 |
| Provider Name | Sydney Colon |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1508551367 PECOS PAC ID: 7214394956 Enrollment ID: I20230612000911 |
| Provider Name | Oluabo Edogiawerie |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1245928456 PECOS PAC ID: 7315280989 Enrollment ID: I20240507003899 |
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