| Ponce Preventive Care Llc | |
|
315 W Ponce De Leon Ave Ste 110 Decatur GA 30030-2441 | |
| (404) 537-2521 | |
| (844) 246-7292 |
| Full Name | Ponce Preventive Care Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 315 W Ponce De Leon Ave Ste 110, Decatur, Georgia |
| Authorized Official Name and Position | Rosa Figueroa (PRACTICE ADMINISTRATOR) |
| Authorized Official Contact | 4045372521 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Ponce Preventive Care Llc 315 W Ponce De Leon Ave Ste 110 Decatur GA 30030-2441 Ph: (404) 537-2521 | Ponce Preventive Care Llc 315 W Ponce De Leon Ave Ste 110 Decatur GA 30030-2441 Ph: (404) 537-2521 |
| NPI Number | 1477865681 |
|---|---|
| Provider Enumeration Date | 07/06/2010 |
| Last Update Date | 05/06/2024 |
| Medicare PECOS PAC ID | 6406987544 |
|---|---|
| Medicare Enrollment ID | O20100706000463 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1477865681 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Secondary |
| 261QP2300X | Clinic/center - Primary Care | 054263 (Georgia) | Primary |
| Provider Name | Chad D Costley |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1700832011 PECOS PAC ID: 8426135427 Enrollment ID: I20080401000511 |
| Provider Name | Alison L English |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1831530559 PECOS PAC ID: 2961645346 Enrollment ID: I20130904000602 |
| Provider Name | Amy C Maresca |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1740612985 PECOS PAC ID: 5890939821 Enrollment ID: I20130913000139 |
| Provider Name | Kristina E Lemene |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1780880823 PECOS PAC ID: 6608963566 Enrollment ID: I20141024000704 |
| Provider Name | Kara Nicole Brown |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1427324342 PECOS PAC ID: 4183990518 Enrollment ID: I20171030001539 |
| Provider Name | Michelle Thomason Sariev |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1902168610 PECOS PAC ID: 9830409234 Enrollment ID: I20171101002013 |
| Provider Name | Nicolas Duchemin |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1245508480 PECOS PAC ID: 5799085882 Enrollment ID: I20191223001853 |
| Provider Name | Angela J Holder |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1114424124 PECOS PAC ID: 8527316603 Enrollment ID: I20210825003262 |
| Provider Name | Savannah Johnson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1841961307 PECOS PAC ID: 4284025214 Enrollment ID: I20211229001145 |
| Provider Name | Tara Noorani |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1124584784 PECOS PAC ID: 9931578465 Enrollment ID: I20221206000404 |
| Provider Name | Morgan Littleton |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1922608678 PECOS PAC ID: 0446629778 Enrollment ID: I20221208002385 |
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