| Proactive Medical Center Llc | |
|
3455 Peachtree Industrial Blvd Ste 910 Duluth GA 30096-6502 | |
| (678) 584-5000 | |
| Not Available |
| Full Name | Proactive Medical Center Llc |
|---|---|
| Speciality | General Practice |
| Location | 3455 Peachtree Industrial Blvd Ste 910, Duluth, Georgia |
| Authorized Official Name and Position | Andrew Hyun (EMPLOYEE) |
| Authorized Official Contact | 7703673325 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Proactive Medical Center Llc 3455 Peachtree Industrial Blvd Ste 910 Duluth GA 30096-6502 Ph: () - | Proactive Medical Center Llc 3455 Peachtree Industrial Blvd Ste 910 Duluth GA 30096-6502 Ph: (678) 584-5000 |
| NPI Number | 1053946004 |
|---|---|
| Provider Enumeration Date | 03/10/2020 |
| Last Update Date | 04/27/2021 |
| Medicare PECOS PAC ID | 0941618227 |
|---|---|
| Medicare Enrollment ID | O20210427000536 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1053946004 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 208D00000X | General Practice | (* (Not Available)) | Primary |
| Provider Name | Jonathon C Allen |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1306853577 PECOS PAC ID: 9739193475 Enrollment ID: I20060201000598 |
| Provider Name | Heidi H Joung |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1932749470 PECOS PAC ID: 3476983800 Enrollment ID: I20200424002755 |
| Provider Name | Jacquelyn Kelly Esterling |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1316557697 PECOS PAC ID: 8325436454 Enrollment ID: I20211022001020 |
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