| Providence Rd Primary Care Llc | |
|
4180 Providence Rd Ste 105 Marietta GA 30062-6186 | |
| (770) 973-4749 | |
| (770) 973-4349 |
| Full Name | Providence Rd Primary Care Llc |
|---|---|
| Speciality | Internal Medicine |
| Location | 4180 Providence Rd, Marietta, Georgia |
| Authorized Official Name and Position | Amma Abunyewa (PROVIDER) |
| Authorized Official Contact | 7709734749 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Providence Rd Primary Care Llc 4180 Providence Rd Ste 105 Marietta GA 30062-6186 Ph: (770) 973-4749 | Providence Rd Primary Care Llc 4180 Providence Rd Ste 105 Marietta GA 30062-6186 Ph: (770) 973-4749 |
| NPI Number | 1831537539 |
|---|---|
| Provider Enumeration Date | 06/05/2013 |
| Last Update Date | 06/05/2013 |
| Medicare PECOS PAC ID | 6709026677 |
|---|---|
| Medicare Enrollment ID | O20130717000763 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1831537539 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | 64774 (Georgia) | Primary |
| Provider Name | Amma Abunyewa |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1982932745 PECOS PAC ID: 4688868243 Enrollment ID: I20101028000330 |
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