| South Atlanta Integrative Medicine | |
|
1240 Highway 54 W Building 700, Suite 700 Fayetteville GA 30214-4557 | |
| (404) 452-9931 | |
| Not Available |
| Full Name | South Atlanta Integrative Medicine |
|---|---|
| Speciality | Family Medicine |
| Location | 1240 Highway 54 W, Fayetteville, Georgia |
| Authorized Official Name and Position | Lynn Stanley (AUTHORIZED OFFICIAL) |
| Authorized Official Contact | 4044529931 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| South Atlanta Integrative Medicine 1240 Highway 54 W Building 700, Suite 700 Fayetteville GA 30214-4557 Ph: (404) 452-9931 | South Atlanta Integrative Medicine 1240 Highway 54 W Building 700, Suite 700 Fayetteville GA 30214-4557 Ph: (404) 452-9931 |
| NPI Number | 1760848980 |
|---|---|
| Provider Enumeration Date | 01/04/2016 |
| Last Update Date | 01/04/2016 |
| Medicare PECOS PAC ID | 3072818145 |
|---|---|
| Medicare Enrollment ID | O20160226002016 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1760848980 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| Provider Name | Lisa J Merritt |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1386917995 PECOS PAC ID: 3173505963 Enrollment ID: I20040604000516 |
| Provider Name | Gina Gonzalez Johnson |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1790846210 PECOS PAC ID: 1254478589 Enrollment ID: I20091020000018 |
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