| Primary Care Services At Lanier Village Estates | |
|
4000 Village View Dr Gainesville GA 30506-4331 | |
| (215) 661-8330 | |
| (215) 661-8336 |
| Full Name | Primary Care Services At Lanier Village Estates |
|---|---|
| Speciality | Internal Medicine |
| Location | 4000 Village View Dr, Gainesville, Georgia |
| Authorized Official Name and Position | Susan Ahern (SVP, CFO) |
| Authorized Official Contact | 2156618330 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Primary Care Services At Lanier Village Estates 420 Delaware Dr Fort Washington PA 19034-2711 Ph: (215) 661-8330 | Primary Care Services At Lanier Village Estates 4000 Village View Dr Gainesville GA 30506-4331 Ph: (215) 661-8330 |
| NPI Number | 1962947408 |
|---|---|
| Provider Enumeration Date | 12/19/2016 |
| Last Update Date | 02/20/2024 |
| Medicare PECOS PAC ID | 5092032284 |
|---|---|
| Medicare Enrollment ID | O20181018001721 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1962947408 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | (* (Not Available)) | Primary |
| Provider Name | Anga Lee M Tipton |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1497739429 PECOS PAC ID: 4486634854 Enrollment ID: I20040726000125 |
| Provider Name | Shiniqua Mona Lee |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1548932577 PECOS PAC ID: 6406294008 Enrollment ID: I20240402001463 |
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