| Prestige Advanced Healthcare | |
|
102 Main St Ste 204 Lagrange GA 30240-3225 | |
| (706) 756-5317 | |
| (844) 740-1379 |
| Full Name | Prestige Advanced Healthcare |
|---|---|
| Speciality | Clinic/center - Primary Care |
| Location | 102 Main St Ste 204, Lagrange, Georgia |
| Authorized Official Name and Position | Cierra Nicole Williams (NURSE PRACTITIONER) |
| Authorized Official Contact | 4702959981 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Prestige Advanced Healthcare 43 Brisbane Ct Newnan GA 30263-2370 Ph: (470) 295-9981 | Prestige Advanced Healthcare 102 Main St Ste 204 Lagrange GA 30240-3225 Ph: (706) 756-5317 |
| NPI Number | 1942736160 |
|---|---|
| Provider Enumeration Date | 05/08/2017 |
| Last Update Date | 10/18/2018 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1942736160 | NPI | - | NPPES |
| 1730557752 | Other | GA | NURSE PRACTITIONER |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | 233631 (Georgia) | Primary |
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