| Saint Joseph's Mercy Care- City Of Refuge | |
|
1300 Joseph E Boone Blvd Nw Atlanta GA 30314-2032 | |
| (678) 843-8500 | |
| (678) 843-8501 |
| Full Name | Saint Joseph's Mercy Care- City Of Refuge |
|---|---|
| Speciality | Clinic/Center |
| Location | 1300 Joseph E Boone Blvd Nw, Atlanta, Georgia |
| Authorized Official Name and Position | E Thomas Andrews (PRESIDENT) |
| Authorized Official Contact | 6788438502 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Saint Joseph's Mercy Care- City Of Refuge 424 Decatur St Se Atlanta GA 30312-1848 Ph: (678) 843-8600 | Saint Joseph's Mercy Care- City Of Refuge 1300 Joseph E Boone Blvd Nw Atlanta GA 30314-2032 Ph: (678) 843-8500 |
| NPI Number | 1689921306 |
|---|---|
| Provider Enumeration Date | 08/13/2012 |
| Last Update Date | 08/11/2015 |
| Medicare PECOS PAC ID | 9931191525 |
|---|---|
| Medicare Enrollment ID | O20150114001050 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1689921306 | NPI | - | NPPES |
| 003132861A | Medicaid | GA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |
| Provider Name | Renee Alli |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1003870874 PECOS PAC ID: 1254622020 Enrollment ID: I20230711003184 |
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