| Romulus Primary Care Services Llc | |
|
4439 Austell Rd Austell GA 30106-1839 | |
| (770) 675-7407 | |
| (770) 693-5922 |
| Full Name | Romulus Primary Care Services Llc |
|---|---|
| Speciality | Family Medicine |
| Location | 4439 Austell Rd, Austell, Georgia |
| Authorized Official Name and Position | Shawntrel Monique Watts (CREDENTIALING MANAGER) |
| Authorized Official Contact | 7706795812 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Romulus Primary Care Services Llc 675 Chestatee Creek Dr Nw Acworth GA 30101-3598 Ph: (678) 977-6919 | Romulus Primary Care Services Llc 4439 Austell Rd Austell GA 30106-1839 Ph: (770) 675-7407 |
| NPI Number | 1972056380 |
|---|---|
| Provider Enumeration Date | 08/02/2016 |
| Last Update Date | 07/11/2024 |
| Medicare PECOS PAC ID | 9436443181 |
|---|---|
| Medicare Enrollment ID | O20160803002527 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1972056380 | NPI | - | NPPES |
| 003145276C | Medicaid | GA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| Provider Name | Jean Joseph Philippe-dambreville |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1639177066 PECOS PAC ID: 7113111089 Enrollment ID: I20101104000715 |
| Provider Name | Rose L Romulus |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1770909236 PECOS PAC ID: 4486972320 Enrollment ID: I20150406001011 |
| Provider Name | James Dylan Lackey |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1205403151 PECOS PAC ID: 9032515473 Enrollment ID: I20210909002101 |
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