| Proactive Collaboration Llc | |
|
4803 Carlene Way Sw Lilburn GA 30047-4705 | |
| (888) 434-9492 | |
| Not Available |
| Full Name | Proactive Collaboration Llc |
|---|---|
| Speciality | General Practice |
| Location | 4803 Carlene Way Sw, Lilburn, Georgia |
| Authorized Official Name and Position | Theresa Gilliard (OWNER) |
| Authorized Official Contact | 8884349492 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Proactive Collaboration Llc 4803 Carlene Way Sw Lilburn GA 30047-4705 Ph: (888) 434-9492 | Proactive Collaboration Llc 4803 Carlene Way Sw Lilburn GA 30047-4705 Ph: (888) 434-9492 |
| NPI Number | 1861253437 |
|---|---|
| Provider Enumeration Date | 01/19/2024 |
| Last Update Date | 01/19/2024 |
| Medicare PECOS PAC ID | 2264877521 |
|---|---|
| Medicare Enrollment ID | O20240227002570 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1861253437 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 208D00000X | General Practice | (* (Not Available)) | Primary |
| Provider Name | Theresa Lynn Harvey-gilliard |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1073870960 PECOS PAC ID: 8325404049 Enrollment ID: I20230522002308 |
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