| Sierra Medical Services, Llc | |
|
528 South 8th Street Griffin GA 30224 | |
| (770) 467-1224 | |
| (770) 467-1225 |
| Full Name | Sierra Medical Services, Llc |
|---|---|
| Speciality | Family Medicine |
| Location | 528 South 8th Street, Griffin, Georgia |
| Authorized Official Name and Position | David A De Lasierra (OWNER) |
| Authorized Official Contact | 3056108620 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Sierra Medical Services, Llc P.o. Box 28170 Macon GA 31221-8170 Ph: (478) 254-5943 | Sierra Medical Services, Llc 528 South 8th Street Griffin GA 30224 Ph: (770) 467-1224 |
| NPI Number | 1588825277 |
|---|---|
| Provider Enumeration Date | 06/24/2008 |
| Last Update Date | 11/10/2010 |
| Medicare PECOS PAC ID | 4688735558 |
|---|---|
| Medicare Enrollment ID | O20081210000632 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1588825277 | NPI | - | NPPES |
| 382655211F | Medicaid | GA | |
| DP1571 | Other | RAILROAD MEDICARE |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | 056820 (Georgia) | Primary |
| Provider Name | David De La Sierra |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1316056369 PECOS PAC ID: 3678591260 Enrollment ID: I20051102000583 |
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