| Pure Health Medicine Llc | |
|
905 Saddle Hl Marietta GA 30068-4915 | |
| (678) 842-8835 | |
| Not Available |
| Full Name | Pure Health Medicine Llc |
|---|---|
| Speciality | Nurse Practitioner |
| Location | 905 Saddle Hl, Marietta, Georgia |
| Authorized Official Name and Position | Paulette Decontee Kpannah (OWNER) |
| Authorized Official Contact | 6785233663 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Pure Health Medicine Llc 3966 Jefferson Township Pkwy Marietta GA 30066-1704 Ph: (678) 523-3663 | Pure Health Medicine Llc 905 Saddle Hl Marietta GA 30068-4915 Ph: (678) 842-8835 |
| NPI Number | 1548833452 |
|---|---|
| Provider Enumeration Date | 07/19/2021 |
| Last Update Date | 09/24/2021 |
| Medicare PECOS PAC ID | 7517365562 |
|---|---|
| Medicare Enrollment ID | O20211006001231 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1548833452 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Secondary |
| 363LF0000X | Nurse Practitioner - Family | (* (Not Available)) | Primary |
| Provider Name | Paulette Decontee Kpannah |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1740882877 PECOS PAC ID: 0941619050 Enrollment ID: I20210430001948 |
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