| Southeastern Primary Care Physicians | |
|
105 Carnegie Pl Ste 103 Fayetteville GA 30214-3980 | |
| (770) 716-7999 | |
| Not Available |
| Full Name | Southeastern Primary Care Physicians |
|---|---|
| Speciality | Internal Medicine |
| Location | 105 Carnegie Pl, Fayetteville, Georgia |
| Authorized Official Name and Position | Cheryl Osborne (PRACTICE MANAGER) |
| Authorized Official Contact | 7707167999 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Southeastern Primary Care Physicians 105 Carnegie Pl Ste 103 Fayetteville GA 30214-3980 Ph: (770) 716-7999 | Southeastern Primary Care Physicians 105 Carnegie Pl Ste 103 Fayetteville GA 30214-3980 Ph: (770) 716-7999 |
| NPI Number | 1972686186 |
|---|---|
| Provider Enumeration Date | 10/23/2006 |
| Last Update Date | 05/08/2008 |
| Medicare PECOS PAC ID | 0840286209 |
|---|---|
| Medicare Enrollment ID | O20040421001408 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1972686186 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | (* (Not Available)) | Primary |
| Provider Name | Richard Bernard Goodjoin |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1306824305 PECOS PAC ID: 0941109722 Enrollment ID: I20060202000022 |
| Provider Name | Poonam Ramani |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1033111349 PECOS PAC ID: 7416052725 Enrollment ID: I20070416000327 |
| Provider Name | Joanne Talley |
|---|---|
| Provider Type | Practitioner - Registered Dietitian Or Nutrition Professional |
| Provider Identifiers | NPI Number: 1245490549 PECOS PAC ID: 4082763172 Enrollment ID: I20090520000224 |
| Provider Name | William R Osborne |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1760572754 PECOS PAC ID: 5294879201 Enrollment ID: I20100215000202 |
| Provider Name | Larry Bergere |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1609966613 PECOS PAC ID: 9638213648 Enrollment ID: I20100215000231 |
| Provider Name | Tamra Jo James Casper |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1659531853 PECOS PAC ID: 8729112925 Enrollment ID: I20100810000254 |
| Provider Name | Roger George Carr |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1215011663 PECOS PAC ID: 6103018973 Enrollment ID: I20101012000627 |
| Provider Name | Shearin Higgs |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1740258896 PECOS PAC ID: 5294875563 Enrollment ID: I20130710000169 |
| Provider Name | Frances Landrum |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1922238260 PECOS PAC ID: 3274822929 Enrollment ID: I20160518002757 |
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